Provider Demographics
NPI:1962953414
Name:PATTERSON, TAYLOR (ATC, LAT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 S 3RD ST APT V
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-6402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PIRATE DR
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:TX
Practice Address - Zip Code:76638-3159
Practice Address - Country:US
Practice Address - Phone:254-486-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT72432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer