Provider Demographics
NPI:1467059873
Name:HENTRICH, PAIGE (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:HENTRICH
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BIG JACK RD
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-8902
Mailing Address - Country:US
Mailing Address - Phone:608-348-2844
Mailing Address - Fax:608-342-5600
Practice Address - Street 1:1240 BIG JACK RD
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-8902
Practice Address - Country:US
Practice Address - Phone:608-348-2844
Practice Address - Fax:608-342-5600
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist