Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251S0007X | Physical Therapist - Sports |
NPI | 1114158656 |
---|---|
Provider Name | Grant Pattee |
First Address | Auburn, MA 01501-5709 |
Second Address | Auburn, MA 01501-5709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2009 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18796 | MA BOARD OF ALLIED HEALTH (01) | MA |