MEDICARE: MS. KAREN NUGENT P.T., C.H.T.

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	174400000X	Specialist	PT12387	CA

General Provider Information

NPI Number	:	1679562649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN NUGENT P.T., C.H.T.

Provider Business Mailing Address
First Line	:	21 TAMAL VISTA BLVD STE 113
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1114
Country	:	US
Telephone Number	:	415-927-2007
Fax Number	:	415-927-7272

Provider Business Practice Location Address
First Line	:	21 TAMAL VISTA BLVD STE 113
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1114
Country	:	US
Telephone Number	:	415-927-2007
Fax Number	:	415-927-7272

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	04/09/2021

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