Provider Demographics
NPI:1720897655
Name:PATERSON, SAMUEL (PTA)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:PATERSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3526
Mailing Address - Country:US
Mailing Address - Phone:401-595-7097
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT ELIZABETH WAY
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2163
Practice Address - Country:US
Practice Address - Phone:401-595-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA00699225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant