Provider Demographics
NPI:1477270551
Name:PAIGE, KIMBERLY ELLEN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELLEN
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 1:3130 HEISTER VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:17853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:414 W MARKET ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842-1076
Practice Address - Country:US
Practice Address - Phone:570-837-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000281225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant