Provider Demographics
NPI:1073685020
Name:VARGAS, REINALDO A (PT)
Entity Type:Individual
Prefix:
First Name:REINALDO
Middle Name:A
Last Name:VARGAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11252 SW 152ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4369
Mailing Address - Country:US
Mailing Address - Phone:305-388-7702
Mailing Address - Fax:305-388-7702
Practice Address - Street 1:11252 SW 152ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4369
Practice Address - Country:US
Practice Address - Phone:305-388-7702
Practice Address - Fax:305-388-7702
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist