Provider Demographics
NPI:1417468307
Name:FLANAGAN, PAIGE (DPT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6495 SHILOH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-1635
Mailing Address - Country:US
Mailing Address - Phone:678-383-6014
Mailing Address - Fax:
Practice Address - Street 1:6495 SHILOH RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-888-3011
Practice Address - Fax:770-888-3011
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA013116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist