Active NPI
Jacqueline Davis Patterson, PT, DPT
- Physical Therapist
- Saint Louis, MO
National Provider Identifier
1659703189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2013028646
- Practice address
- 4616 Lindell Blvd
Apt 204
Saint Louis, MO 63108-3723 - Phone
- (734) 678-8424
- Fax
- (314) 735-4468
- NPI assigned
- Aug 7, 2013
- Sex
- Female
- 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 Therapist | 225100000X | 2013028646 | MO | Primary |
Addresses
Primary practice location
4616 Lindell Blvd
Apt 204
Saint Louis, MO 63108-3723
Mailing address
4616 Lindell Blvd
Apt 204
Saint Louis, MO 63108-3723
Phone (734) 678-8424
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 |
|---|---|---|---|
| 2013028646 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375833600000",
"number": "1659703189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4616 LINDELL BLVD",
"address_2": "APT 204",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631083723",
"telephone_number": "734-678-8424",
"fax_number": "314-735-4468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4616 LINDELL BLVD",
"address_2": "APT 204",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631083723",
"telephone_number": "734-678-8424",
"fax_number": "314-735-4468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERSON",
"first_name": "JACQUELINE",
"middle_name": "DAVIS",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-07",
"last_updated": "2013-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2013028646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.