Provider Demographics
NPI:1376386490
Name:SOMERVILLE, PAIGE NICOLE (DPT, PT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:NICOLE
Last Name:SOMERVILLE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7872 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-8005
Mailing Address - Country:US
Mailing Address - Phone:952-512-2470
Mailing Address - Fax:952-512-2479
Practice Address - Street 1:110105 PIONEER TRL W STE 201
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2680
Practice Address - Country:US
Practice Address - Phone:952-512-2470
Practice Address - Fax:952-512-2479
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN13693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist