Provider Demographics
NPI:1881026508
Name:RAAB, PAIGE E (PT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:E
Last Name:RAAB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:E
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2906 CROSSING COURT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822
Mailing Address - Country:US
Mailing Address - Phone:217-398-9800
Mailing Address - Fax:217-366-0037
Practice Address - Street 1:2906 CROSSING COURT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6163
Practice Address - Country:US
Practice Address - Phone:217-398-9800
Practice Address - Fax:217-366-0037
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist