Healthcare Provider Details

I. General information

NPI: 1164374898
Provider Name (Legal Business Name): PAIGE PEDIATRIC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5013 DESPESTRE ST
DANIEL ISLAND SC
29492-8085
US

IV. Provider business mailing address

5013 DESPESTRE ST
DANIEL ISLAND SC
29492-8085
US

V. Phone/Fax

Practice location:
  • Phone: 916-217-8065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAIGE MILAVICKAS
Title or Position: PEDIATRIC PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 916-217-8065