Provider Demographics
NPI:1104004498
Name:VARGAS, ALBA MERCEDES (PT)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:MERCEDES
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 69
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-0069
Mailing Address - Country:US
Mailing Address - Phone:435-652-4455
Mailing Address - Fax:435-652-4472
Practice Address - Street 1:1490 E FOREMASTER DR STE 110
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4492
Practice Address - Country:US
Practice Address - Phone:435-652-4455
Practice Address - Fax:435-652-4472
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT78237303-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000093640Medicare PIN