Provider Demographics
NPI:1548838337
Name:PATTERSON, KRISTEN ASHLEY (LMT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ASHLEY
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 ASTER HAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-6261
Mailing Address - Country:US
Mailing Address - Phone:703-915-7885
Mailing Address - Fax:
Practice Address - Street 1:6213 ASTER HAVEN CIR
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6261
Practice Address - Country:US
Practice Address - Phone:703-915-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019015013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist