Provider Demographics
NPI:1871369447
Name:PATRINO, GRACE ANNE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:PATRINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 FRANK THOMAS AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2547
Mailing Address - Country:US
Mailing Address - Phone:630-605-3037
Mailing Address - Fax:
Practice Address - Street 1:801 FRANK THOMAS AVE APT 314
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2547
Practice Address - Country:US
Practice Address - Phone:630-605-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer