Provider Demographics
NPI:1730546789
Name:PAGE-HOUGH, PAULA (PTA, DPT)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:PAGE-HOUGH
Suffix:
Gender:F
Credentials:PTA, DPT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1560 N MEADOWCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-5757
Mailing Address - Country:US
Mailing Address - Phone:352-228-4088
Mailing Address - Fax:352-228-4006
Practice Address - Street 1:1560 N MEADOWCREST BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-5757
Practice Address - Country:US
Practice Address - Phone:352-228-4088
Practice Address - Fax:352-228-4006
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA16647225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant