Basic Information
| Provider Information | |||||||||
| NPI: | 1639150667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KARGO | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 HENRY ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274053669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363754263 | ||||||||
| FaxNumber: | 3363754262 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 HENRY ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274053669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363754263 | ||||||||
| FaxNumber: | 3363754262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 12/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9249 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7211367 | 05 | NC | MEDICAID | C4757 | 01 | NC | MEDCOST | OTHER | 078U8 | 01 | NC | BCBS | OTHER | 2500823B | 01 | NC | MEDICARE PT | OTHER | P00010442 | 01 | NC | MEDICARE RAILROAD | OTHER |