Active NPI
Destry Quade Patterson, PTA
- Physical Therapy Assistant
- New Orleans, LA
National Provider Identifier
1164022141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A10739
- Practice address
- 1415 Tulane Ave
New Orleans, LA 70112-2600 - Phone
- (504) 988-5263
- NPI assigned
- Oct 28, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A10739 | LA | Primary |
Addresses
Primary practice location
1415 Tulane Ave
New Orleans, LA 70112-2600
Mailing address
2636 Somerset Dr
New Orleans, LA 70131-5228
Phone (504) 206-9000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A10739 | LA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1164022141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2636 SOMERSET DR",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701315228",
"telephone_number": "504-206-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 TULANE AVE",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701122600",
"telephone_number": "504-988-5263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERSON",
"first_name": "DESTRY",
"middle_name": "QUADE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-28",
"last_updated": "2020-10-28",
"certification_date": "2020-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "LA",
"license": "A10739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Orleans, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.