Provider Demographics
NPI:1588650584
Name:KARNOFSKI, ROGER JOHN (PT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:JOHN
Last Name:KARNOFSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0302
Mailing Address - Country:US
Mailing Address - Phone:360-414-2048
Mailing Address - Fax:360-575-6749
Practice Address - Street 1:852 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2406
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:360-501-3755
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR120308Medicaid
WA132410OtherLABOR & IND.
WA8340838Medicaid
WAAB12136Medicare PIN
WA132410OtherLABOR & IND.