Provider Demographics
NPI:1487808176
Name:COUSER, PATRICIA DRUMMOND (CMT,LMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DRUMMOND
Last Name:COUSER
Suffix:
Gender:F
Credentials:CMT,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 SHORECREST LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-6000
Mailing Address - Country:US
Mailing Address - Phone:757-754-8362
Mailing Address - Fax:757-594-9830
Practice Address - Street 1:753 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3564
Practice Address - Country:US
Practice Address - Phone:757-754-8362
Practice Address - Fax:757-594-9830
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA184809225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist