MEDICARE: KAREN POAGUE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1537	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00617748	OTHER	OR	RRMC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	084171005	OTHER	OR	BCBS

General Provider Information

NPI Number	:	1225014533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN POAGUE PT

Provider Business Mailing Address
First Line	:	5781 MAIN ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97478-5426
Country	:	US
Telephone Number	:	541-654-0282
Fax Number	:	541-654-0819

Provider Business Practice Location Address
First Line	:	5781 MAIN ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97478-5426
Country	:	US
Telephone Number	:	541-654-0282
Fax Number	:	541-654-0819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/15/2014

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Directions to “ KAREN POAGUE PT” Practice Location

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