Provider Demographics
NPI:1679902142
Name:GOLDAMMER, PATTY LYNN (LPTA)
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:LYNN
Last Name:GOLDAMMER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2117
Mailing Address - Country:US
Mailing Address - Phone:231-627-2031
Mailing Address - Fax:
Practice Address - Street 1:761 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2117
Practice Address - Country:US
Practice Address - Phone:231-627-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003468225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant