Provider Demographics
NPI:1437604410
Name:PAGE, STEPHEN EARL (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EARL
Last Name:PAGE
Suffix:
Gender:M
Credentials:PT
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 1902
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0902
Mailing Address - Country:US
Mailing Address - Phone:570-208-5534
Mailing Address - Fax:570-208-5556
Practice Address - Street 1:115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517-1415
Practice Address - Country:US
Practice Address - Phone:570-562-7770
Practice Address - Fax:570-208-5556
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist