Provider Demographics
NPI:1083340459
Name:VARGAS, KATHLEEN SOLIVEN (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SOLIVEN
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:PO BOX 2350
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-8350
Mailing Address - Country:US
Mailing Address - Phone:347-829-3890
Mailing Address - Fax:347-829-3888
Practice Address - Street 1:1 BLUE HILL PLAZA, SUITE 1509
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965
Practice Address - Country:US
Practice Address - Phone:877-839-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2023-10-19
Deactivation Date:2023-03-13
Deactivation Code:
Reactivation Date:2023-10-19
Provider Licenses
StateLicense IDTaxonomies
NY048699-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist