Individual
MR. JACOB CHANNING PATTENGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
240 S MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63703-4918
(573) 334-6711
Mailing address
1908 SUE ANNE TRAIL, CAPE GIRARDEAU, MO 63701
(573) 334-7657
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002029012
LICENSE#
MO
Enumeration date
11/07/2006
Last updated
12/15/2009
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