MEDICARE: JAMES E POGUE RPT, INC

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

General Provider Information

NPI Number	:	1669788048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES E POGUE RPT, INC

Provider Business Mailing Address
First Line	:	3290 PROFESSIONAL DR STE A
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95602-2490
Country	:	US
Telephone Number	:	530-885-9024
Fax Number	:	530-885-5064

Provider Business Practice Location Address
First Line	:	3290 PROFESSIONAL DR STE A
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95602-2490
Country	:	US
Telephone Number	:	530-885-9024
Fax Number	:	530-885-5064

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES E POGUE
Credential	:	RPT
Telephone Number	:	530-885-9024

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	08/24/2010

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