Provider Demographics
NPI:1538317342
Name:PERMAR, GAGE (DPT)
Entity type:Individual
Prefix:MR
First Name:GAGE
Middle Name:
Last Name:PERMAR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:143 N MCCORMICK ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2725
Mailing Address - Country:US
Mailing Address - Phone:928-589-1172
Mailing Address - Fax:928-441-2622
Practice Address - Street 1:143 N MCCORMICK ST STE 102
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2725
Practice Address - Country:US
Practice Address - Phone:928-589-1172
Practice Address - Fax:928-441-2622
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ148080Medicare PIN