1598779076 NPI number — KARMA M SAGE-JOHNSON PT

Table of content: KARMA M SAGE-JOHNSON PT (NPI 1598779076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598779076 NPI number — KARMA M SAGE-JOHNSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAGE-JOHNSON
Provider First Name:
KARMA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAGE
Provider Other First Name:
KARMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598779076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1106 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-788-0805
Provider Business Mailing Address Fax Number:
805-788-0845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 POSADA LN
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
TEMPLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93465-4059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-434-2050
Provider Business Practice Location Address Fax Number:
805-434-0065
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070-015879 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT27028 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT27028 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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