Individual
ROBERT J PATTILLO
Active
Individual
ROBERT J PATTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
827
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
79263
—
NM
01
—
NM00Q162
BLUE CROSS BLUE SHIELD
NM
Enumeration date
08/25/2005
Last updated
06/10/2011
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