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NPI Code Detail

MEDICARE: MRS. LAURIE ANN PAGE PT

MEDICARE: MRS. LAURIE ANN PAGE PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist003461CT

General Provider Information

NPI Number : 1912278706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURIE ANN PAGE PT
Provider Business Mailing Address
First Line : 1775 BOSTON POST RD
Second Line :
City : OLD SAYBROOK
State : CT
Zip : 06475-1643
Country : US
Telephone Number : 860-399-6216
Fax Number : 860-399-4053
Provider Business Practice Location Address
First Line : 1775 BOSTON POST RD
Second Line :
City : OLD SAYBROOK
State : CT
Zip : 06475-1643
Country : US
Telephone Number : 860-399-6216
Fax Number : 860-399-4053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2012
Last Update Date : 01/25/2012

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