=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215493820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE LASSEN DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2019
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 ALEXANDER DR STE 4
-----------------------------------------------------
City | TIPTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52772-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-886-3421
-----------------------------------------------------
Fax | 563-886-2083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1130 S SCOTT BLVD STE 1
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52240-2907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-569-2969
-----------------------------------------------------
Fax | 319-338-5775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 093471
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------