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General NPI Number Information
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NPI Number | 1588542302
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Entity Type | Individual
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Provider Name | GAGE KASPERIAN
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Gender |
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 64 S STAR RD # 2
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City | STAR
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State | ID
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Zip | 83669-5497
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Country | US
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Telephone | 208-488-4250
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Fax |
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Provider Business Mailing Address
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Address Line | 828 6TH ST N
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City | NAMPA
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State | ID
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Zip | 83687-3323
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Country | US
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Telephone | 912-237-5283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA004864
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 8871462
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License Number State | ID
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