Provider Demographics
NPI:1407035264
Name:PATTEN, JANICE COSTELLO (P T)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:COSTELLO
Last Name:PATTEN
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-6336
Mailing Address - Country:US
Mailing Address - Phone:978-422-0195
Mailing Address - Fax:978-422-0195
Practice Address - Street 1:2 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MA
Practice Address - Zip Code:01564-2150
Practice Address - Country:US
Practice Address - Phone:978-422-0195
Practice Address - Fax:978-422-0195
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist