Provider Demographics
NPI:1548024474
Name:PATTERSON, LEOMIE VICTORIA (LBMT)
Entity type:Individual
Prefix:
First Name:LEOMIE
Middle Name:VICTORIA
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LBMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4112
Mailing Address - Country:US
Mailing Address - Phone:919-601-6054
Mailing Address - Fax:
Practice Address - Street 1:5301 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3822
Practice Address - Country:US
Practice Address - Phone:919-629-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist