Provider Demographics
NPI:1396134052
Name:PATTERSON, WESLEY (MS ATC/L)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MS ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 SWANSON COVE CT
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16700 SWANSON COVE CT
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20637-2804
Practice Address - Country:US
Practice Address - Phone:240-320-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2018-04-25
Deactivation Date:2018-01-25
Deactivation Code:
Reactivation Date:2018-04-25
Provider Licenses
StateLicense IDTaxonomies
MDA00005242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer