Provider Demographics
NPI:1992701171
Name:POGUE, JAMES E (RPT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:POGUE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3290 PROFESSIONAL DR
Mailing Address - Street 2:STE A
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2490
Mailing Address - Country:US
Mailing Address - Phone:530-885-5064
Mailing Address - Fax:530-885-9024
Practice Address - Street 1:3290 PROFESSIONAL DR
Practice Address - Street 2:STE A
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2490
Practice Address - Country:US
Practice Address - Phone:530-885-5064
Practice Address - Fax:530-885-9024
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT59960Medicare ID - Type Unspecified