=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679594790
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE B PLASH PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 03/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5420 HIGHWAY 90 W TILLMAN'S CORNER
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36619-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-660-1505
-----------------------------------------------------
Fax | 251-660-9007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 MCGREGOR AVE S
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36608-1823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-660-1505
-----------------------------------------------------
Fax | 256-350-7757
-----------------------------------------------------
=====================================================
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 | PTH607
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------