Provider Demographics
NPI:1679674709
Name:DAVIDSON, PAIGE (PT, DPT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 SIPAPU ST
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6498
Mailing Address - Country:US
Mailing Address - Phone:575-758-8761
Mailing Address - Fax:888-492-8273
Practice Address - Street 1:414 SIPAPU ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6498
Practice Address - Country:US
Practice Address - Phone:575-758-8761
Practice Address - Fax:888-492-8273
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7321225100000X
NM4987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5644211YUFCOtherMEDICARE #
NM34402501Medicaid