Provider Demographics
NPI:1356187934
Name:LEIBERT, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:LEIBERT
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 1:193 N 350 W APT B
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-4714
Mailing Address - Country:US
Mailing Address - Phone:972-832-4033
Mailing Address - Fax:
Practice Address - Street 1:13552 S 110 W STE 204
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2403
Practice Address - Country:US
Practice Address - Phone:801-432-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program