Provider Demographics
NPI:1134370380
Name:DEVINE, PATTY (PT)
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1158
Mailing Address - Country:US
Mailing Address - Phone:508-347-8141
Mailing Address - Fax:508-347-7576
Practice Address - Street 1:179 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1158
Practice Address - Country:US
Practice Address - Phone:508-347-8141
Practice Address - Fax:508-347-7576
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist