Provider Demographics
NPI:1235539321
Name:PHALEN, PAIGE
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:PHALEN
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:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84310-0515
Mailing Address - Country:US
Mailing Address - Phone:801-745-5667
Mailing Address - Fax:
Practice Address - Street 1:1435 VILLAGE DR
Practice Address - Street 2:DEPT. 2801
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-5150
Practice Address - Country:US
Practice Address - Phone:801-626-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer