Provider Demographics
NPI:1962880518
Name:PATTERSON, KEITH (LAT)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N LOOP 340
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2573
Mailing Address - Country:US
Mailing Address - Phone:254-299-6822
Mailing Address - Fax:254-799-1831
Practice Address - Street 1:555 N LOOP 340
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2573
Practice Address - Country:US
Practice Address - Phone:254-299-6822
Practice Address - Fax:254-799-1831
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT18472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer