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General NPI Number Information
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NPI Number | 1629615679
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Entity Type | Individual
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Provider Name | PAIGE ARDIS
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Gender | Female
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 17557 CLARIDGE OVAL W
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City | BOCA RATON
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State | FL
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Zip | 33496-1336
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Country | US
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Telephone | 561-451-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 4936 PELICAN ST
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2426
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Country | US
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Telephone | 954-254-0379
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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 | PTA29926
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License Number State | FL
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