Provider Demographics
NPI:1619233574
Name:DIERKS, PAIGE A (PTA)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:A
Last Name:DIERKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:A
Other - Last Name:CURETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:444 FOUR STATES DR
Mailing Address - Street 2:STE 1
Mailing Address - City:GALENA
Mailing Address - State:KS
Mailing Address - Zip Code:66739-4324
Mailing Address - Country:US
Mailing Address - Phone:620-783-4441
Mailing Address - Fax:620-783-4090
Practice Address - Street 1:444 FOUR STATES DR
Practice Address - Street 2:STE 1
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4324
Practice Address - Country:US
Practice Address - Phone:620-783-4441
Practice Address - Fax:620-783-4090
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028879225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant