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NPI Code Detail

MEDICARE: KOREN E SEAGO MS,PT

MEDICARE: KOREN E SEAGO MS,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
1225100000XPhysical Therapist05009222AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105009222AOTHERINPHYSICAL THERAPY LICENSE

General Provider Information

NPI Number : 1821117904
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOREN E SEAGO MS,PT
Provider Business Mailing Address
First Line : 14630 E WALNUT RUN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46814-8907
Country : US
Telephone Number : 765-506-0745
Fax Number :
Provider Business Practice Location Address
First Line : 3840 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1708
Country : US
Telephone Number : 260-483-2422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 04/02/2015

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Directions to “ KOREN E SEAGO MS,PT” Practice Location

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