Individual
MR. JERRY W PAIGE
Active
Individual
MR. JERRY W PAIGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
00457
LA
261QP2000X
Physical Therapy Clinic/Center
Primary
00457
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650013713
RAILROAD MEDICARE
LA
Enumeration date
10/05/2005
Last updated
06/16/2008
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