Provider Demographics
NPI:1174504104
Name:KARGO, RAYMOND (MSPT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:KARGO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 LENDEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7033
Mailing Address - Country:US
Mailing Address - Phone:336-275-7405
Mailing Address - Fax:336-275-3320
Practice Address - Street 1:1915 LENDEW STREET
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7033
Practice Address - Country:US
Practice Address - Phone:336-275-7405
Practice Address - Fax:336-275-3320
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC4594OtherMEDCOST
NC7211330Medicaid
NCP00010441OtherMEDICARE RAILROAD
NC2500795AOtherMEDICARE PHYICAL THERAPY
NC078U7OtherBCBS