Provider Demographics
NPI:1730646332
Name:GRAHAM, PAIGE E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:E
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:E
Other - Last Name:LINCICUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:8837 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2725
Practice Address - Country:US
Practice Address - Phone:414-257-0300
Practice Address - Fax:414-257-0330
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
WI15411-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist