Provider Demographics
NPI:1528097086
Name:PAGE, CLINT JR (PT)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:PAGE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:746 E AURORA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2732
Mailing Address - Country:US
Mailing Address - Phone:330-908-0211
Mailing Address - Fax:330-908-0211
Practice Address - Street 1:746 E AURORA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2732
Practice Address - Country:US
Practice Address - Phone:330-908-0039
Practice Address - Fax:330-908-0211
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH011178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist