Provider Demographics
NPI:1255605093
Name:CHENOWETH-ALLEN, PAIGE CARISSA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:CARISSA
Last Name:CHENOWETH-ALLEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:CARISSA
Other - Last Name:CHENOWETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4146 JUNIATA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-3931
Mailing Address - Country:US
Mailing Address - Phone:951-359-6172
Mailing Address - Fax:
Practice Address - Street 1:12111 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2609
Practice Address - Country:US
Practice Address - Phone:850-236-7497
Practice Address - Fax:850-236-7499
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38588225100000X
MO2017018683225100000X
FL29954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist