Provider Demographics
NPI:1720707508
Name:PAGE, STEPHEN BRYCE (DPT, CERT DN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRYCE
Last Name:PAGE
Suffix:
Gender:M
Credentials:DPT, CERT DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 JEFFERSON STREET
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440
Mailing Address - Country:US
Mailing Address - Phone:601-399-0534
Mailing Address - Fax:
Practice Address - Street 1:1002 JEFFERSON STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440
Practice Address - Country:US
Practice Address - Phone:601-399-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist