Provider Demographics
NPI:1063631273
Name:VARGAS, MAYTE (PT)
Entity Type:Individual
Prefix:
First Name:MAYTE
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1723
Mailing Address - Country:US
Mailing Address - Phone:954-435-5300
Mailing Address - Fax:
Practice Address - Street 1:15766 NW 10TH ST # P
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1604
Practice Address - Country:US
Practice Address - Phone:516-384-2568
Practice Address - Fax:954-435-8880
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019864225100000X, 2251C2600X
FL38765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ12R01Medicare ID - Type UnspecifiedMEDICARE