Provider Demographics
NPI:1326317553
Name:PAIGE, ANNABELLE CAASI
Entity Type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:CAASI
Last Name:PAIGE
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 1:2315 BEACH BLVD
Mailing Address - Street 2:STE #301
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4073
Mailing Address - Country:US
Mailing Address - Phone:843-475-6737
Mailing Address - Fax:
Practice Address - Street 1:23 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4316
Practice Address - Country:US
Practice Address - Phone:203-834-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22494222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22494OtherPHYSICAL THERAPY ASSISTANT