Provider Demographics
NPI:1013136472
Name:PAGE, ELIZABETH RORIE (PT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:RORIE
Last Name:PAGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PALMER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-8111
Mailing Address - Country:US
Mailing Address - Phone:928-855-9927
Mailing Address - Fax:
Practice Address - Street 1:1951 MESQUITE AVE
Practice Address - Street 2:SUITE # I
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5746
Practice Address - Country:US
Practice Address - Phone:928-680-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1886225100000X
NC22942251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ780352Medicaid