Provider Demographics
NPI:1811515786
Name:PEREZ, PAIGE E (PT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:E
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:CLAPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 10
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-0010
Mailing Address - Country:US
Mailing Address - Phone:707-303-4992
Mailing Address - Fax:707-303-4996
Practice Address - Street 1:208 CONCOURSE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8210
Practice Address - Country:US
Practice Address - Phone:707-303-4992
Practice Address - Fax:707-303-4996
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4278208100000X
CAPT300113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation