=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962927897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE A CHAMBERLAIN DPT, MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2017
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 W LAKEWAY RD STE 200
-----------------------------------------------------
City | GILLETTE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82718-6341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 73-879-8503
-----------------------------------------------------
Fax | 307-387-9890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 W LAKEWAY RD STE 1004
-----------------------------------------------------
City | GILLETTE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82718-6349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-387-9850
-----------------------------------------------------
Fax | 307-387-9890
-----------------------------------------------------
=====================================================
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 | PT-1970
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------