Provider Demographics
NPI:1902814510
Name:SCHABERG, KIM NGO (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:NGO
Last Name:SCHABERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:Y
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2234-B W HOUSTON
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3519
Mailing Address - Country:US
Mailing Address - Phone:918-259-1888
Mailing Address - Fax:918-251-3725
Practice Address - Street 1:2232 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3529
Practice Address - Country:US
Practice Address - Phone:918-259-9522
Practice Address - Fax:918-259-9521
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200044970AMedicaid
OK339268YUQZMedicare PIN