Provider Demographics
NPI:1194392993
Name:LALANCETTE, PATRICK TIMOTHY (PTA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:TIMOTHY
Last Name:LALANCETTE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 RIDGEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3447
Mailing Address - Country:US
Mailing Address - Phone:720-232-4395
Mailing Address - Fax:
Practice Address - Street 1:1107 W CENTURY DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1693
Practice Address - Country:US
Practice Address - Phone:720-507-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014983225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant