MEDICARE: KARLA DEE PAPENFUSS 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
2	225100000X	Physical Therapist	7032	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003003	OTHER	CT	LICENSE#

General Provider Information

NPI Number	:	1588773303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA DEE PAPENFUSS PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	315 MEDICAL PKWY
Second Line	:	STE 150
City	:	GREER
State	:	SC
Zip	:	29650-2456
Country	:	US
Telephone Number	:	864-797-9600
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/09/2015

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