Provider Demographics
NPI:1184704371
Name:RAFFO, PAIGE (MPT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:RAFFO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13033 NE 102ND PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5246
Mailing Address - Country:US
Mailing Address - Phone:805-794-3835
Mailing Address - Fax:805-794-3835
Practice Address - Street 1:2820 NORTHUP WAY
Practice Address - Street 2:SUITE 245
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1419
Practice Address - Country:US
Practice Address - Phone:805-794-3835
Practice Address - Fax:805-794-3835
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT284512251X0800X
WAPT 601342812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ47368Medicare UPIN
CAPT28451Medicare ID - Type Unspecified