Provider Demographics
NPI:1033166723
Name:MEJIA-VARGAS, ALAIN D SR (RPT)
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:D
Last Name:MEJIA-VARGAS
Suffix:SR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:ALAIN
Other - Middle Name:
Other - Last Name:MEJIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14320 ROTTERDAM RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6416
Mailing Address - Country:US
Mailing Address - Phone:574-952-1457
Mailing Address - Fax:
Practice Address - Street 1:14320 ROTTERDAM RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6416
Practice Address - Country:US
Practice Address - Phone:574-952-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008497A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist