Provider Demographics
NPI:1851415558
Name:PATENAUDE, PAUL GARY (PTA 11424 (FL))
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GARY
Last Name:PATENAUDE
Suffix:
Gender:M
Credentials:PTA 11424 (FL)
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Mailing Address - Street 1:9393 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4140
Mailing Address - Country:US
Mailing Address - Phone:727-575-7955
Mailing Address - Fax:727-575-7956
Practice Address - Street 1:9393 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4140
Practice Address - Country:US
Practice Address - Phone:727-575-7955
Practice Address - Fax:727-575-7956
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 11424225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant