It runs for 105 kilometres from the eastern slopes of Mount Taranaki, passing east through Stratford before swinging south and reaching the South Taranaki Bight near the town of Patea.

The river was the original portal to South Taranaki for both Māori and Europeans.

Many enjoy canoeing in the Pātea River—it is the only navigable river in South Taranaki.

[citation needed] Lake Rotorangi on the river is the longest man-made lake in New Zealand (46 km), formed when the Egmont Electric Power Board built the Patea Dam in 1980–84.

The interesting southern access drive is via Ball Road through Alton and Hurleyville.