Provider Demographics
NPI:1215493820
Name:LASSEN, PAIGE (DPT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:LASSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1130 S SCOTT BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-2907
Mailing Address - Country:US
Mailing Address - Phone:319-569-2969
Mailing Address - Fax:319-338-5775
Practice Address - Street 1:100 ALEXANDER DR STE 4
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-2304
Practice Address - Country:US
Practice Address - Phone:563-886-3421
Practice Address - Fax:563-886-2083
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist