Provider Demographics
NPI:1184034225
Name:KOEHNE, PAIGE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:KOEHNE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 139
Mailing Address - Street 2:139 MAIN ST NW
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-0139
Mailing Address - Country:US
Mailing Address - Phone:763-269-8065
Mailing Address - Fax:763-433-8134
Practice Address - Street 1:1574 154TH AVE NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304
Practice Address - Country:US
Practice Address - Phone:763-433-8108
Practice Address - Fax:763-433-8134
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN9142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist