Healthcare Provider Details

I. General information

NPI: 1376686428
Provider Name (Legal Business Name): MARGARET PAINE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 TULIP TREE DR
PRINCETON IN
47670-2300
US

IV. Provider business mailing address

1516 S NORMAN AVE
EVANSVILLE IN
47714-3668
US

V. Phone/Fax

Practice location:
  • Phone: 812-387-2938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002824A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: