Provider Demographics
NPI:1841871472
Name:SHORTRIDGE, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:SHORTRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 ELLIS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8809
Mailing Address - Country:US
Mailing Address - Phone:406-587-4501
Mailing Address - Fax:
Practice Address - Street 1:1532 ELLIS ST STE 201
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8809
Practice Address - Country:US
Practice Address - Phone:406-587-4501
Practice Address - Fax:406-587-3919
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-19466208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation