Provider Demographics
NPI:1588542302
Name:KASPERIAN, GAGE
Entity type:Individual
Prefix:
First Name:GAGE
Middle Name:
Last Name:KASPERIAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 6TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-3323
Mailing Address - Country:US
Mailing Address - Phone:912-237-5283
Mailing Address - Fax:
Practice Address - Street 1:64 S STAR RD # 2
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5497
Practice Address - Country:US
Practice Address - Phone:208-488-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004864225200000X
ID8871462225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant