Provider Demographics
NPI:1427306380
Name:PATTERSON, LANCE A (PT)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 W UNIVERSITY BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2999
Mailing Address - Country:US
Mailing Address - Phone:580-920-2231
Mailing Address - Fax:580-920-2242
Practice Address - Street 1:3004 W UNIVERSITY BLVD
Practice Address - Street 2:STE 101
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2999
Practice Address - Country:US
Practice Address - Phone:580-920-2231
Practice Address - Fax:580-920-2242
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100832780 AMedicaid