Provider Demographics
NPI:1457169542
Name:PATTERSON, KIERRA (PTA)
Entity type:Individual
Prefix:
First Name:KIERRA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 COLINA DORADA DR APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2891
Mailing Address - Country:US
Mailing Address - Phone:347-853-2877
Mailing Address - Fax:
Practice Address - Street 1:2345 E 8TH ST STE 106&107
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2800
Practice Address - Country:US
Practice Address - Phone:619-323-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51693225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant