Provider Demographics
NPI:1184270589
Name:TRUDEAU, PAIGE ELLEN RENEE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELLEN RENEE
Last Name:TRUDEAU
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 1:6495 FRANCIS LOOP SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8210
Mailing Address - Country:US
Mailing Address - Phone:248-459-6750
Mailing Address - Fax:
Practice Address - Street 1:6495 FRANCIS LOOP SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8210
Practice Address - Country:US
Practice Address - Phone:248-459-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60959280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist