Provider Demographics
NPI:1043425598
Name:POGUE, CHAD A (MPT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:A
Last Name:POGUE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12952 BANDERA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4689
Mailing Address - Country:US
Mailing Address - Phone:210-372-9600
Mailing Address - Fax:210-372-0211
Practice Address - Street 1:11219 POTRANCO RD BLDG A
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5848
Practice Address - Country:US
Practice Address - Phone:210-679-6900
Practice Address - Fax:210-679-6904
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2102303Medicaid
TX8T7682OtherBLUE CROSS BLUE SHIELD
TX2102303Medicaid