Individual
PAIGE NICOLE REGINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
1123 BENNINGTON DR, MISHAWAKA, IN 46544-6219
(574) 344-3707
Mailing address
1123 BENNINGTON DR., MISHAWAKA, IN 46544
(574) 344-3707
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004987
MI
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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