Provider Demographics
NPI:1255685293
Name:PAGE, JEREMY KEITH (RKT, CBIS)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:KEITH
Last Name:PAGE
Suffix:
Gender:M
Credentials:RKT, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 NORTH HAMILTON STREET
Mailing Address - Street 2:APARTMENT G
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221
Mailing Address - Country:US
Mailing Address - Phone:804-675-5000
Mailing Address - Fax:
Practice Address - Street 1:805 N HAMILTON ST
Practice Address - Street 2:APARTMENT G
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-1241
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist