Healthcare Provider Details

I. General information

NPI: 1326894544
Provider Name (Legal Business Name): ANDREW PAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S 18TH ST
MOREHEAD CITY NC
28557-4021
US

IV. Provider business mailing address

204 S 18TH ST
MOREHEAD CITY NC
28557-4021
US

V. Phone/Fax

Practice location:
  • Phone: 540-529-6871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: