Provider Demographics
NPI:1386614972
Name:PATTERSON, ELIZABETH A (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RITCHIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3916
Mailing Address - Country:US
Mailing Address - Phone:410-647-1961
Mailing Address - Fax:410-647-8276
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-647-1961
Practice Address - Fax:410-647-8276
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD574GMedicare PIN
MD270P574GMedicare PIN