Provider Demographics
NPI:1598779076
Name:SAGE, KARMA M (PT)
Entity Type:Individual
Prefix:
First Name:KARMA
Middle Name:M
Last Name:SAGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WALNUT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2416
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:350 POSADA LN
Practice Address - Street 2:103
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4059
Practice Address - Country:US
Practice Address - Phone:805-434-2050
Practice Address - Fax:805-434-0065
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27028225100000X
IL070-015879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27028OtherPHYSICAL THERAPY LICENSE
CABX481ZMedicare PIN