Individual
KOREN E SEAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,PT
Contact information
Practice address
3840 NEW VISION DR, FORT WAYNE, IN 46845-1708
(260) 483-2422
Mailing address
14630 E WALNUT RUN, FORT WAYNE, IN 46814-8907
(765) 506-0745
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05009222A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05009222A
PHYSICAL THERAPY LICENSE
IN
Enumeration date
03/28/2007
Last updated
04/02/2015
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