Provider Demographics
NPI:1225263965
Name:PAIGE, TIFFANY CHARMAINE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHARMAINE
Last Name:PAIGE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 SOUTHBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8814
Mailing Address - Country:US
Mailing Address - Phone:843-245-0579
Mailing Address - Fax:
Practice Address - Street 1:4015 SOUTHBOROUGH RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8814
Practice Address - Country:US
Practice Address - Phone:843-245-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist