Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1886 | AZ |
N | 2251P0200X | Physical Therapist - Pediatrics | 2294 | NC |
NPI | 1013136472 |
---|---|
Provider Name | Ms. Elizabeth Rorie Page |
First Address | Lake Havasu City, AZ 86406-8111 |
Second Address | Lake Havasu City, AZ 86403-5746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
780352 | (05) | AZ |