Koren E Seago, MS,PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05009222A Issued in IN

Practice address

3840 New Vision Dr
Fort Wayne, IN 46845-1708

Phone

(260) 483-2422

NPI assigned

Mar 28, 2007

Last updated

Apr 2, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427932800000",
    "number": "1821117904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14630 E WALNUT RUN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468148907",
            "telephone_number": "765-506-0745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451708",
            "telephone_number": "260-483-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEAGO",
        "first_name": "KOREN",
        "middle_name": "E",
        "credential": "MS,PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2015-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05009222A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "05009222A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.