Provider Demographics
NPI:1295218154
Name:VARGO, KEVIN GREGORY
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:GREGORY
Last Name:VARGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 ARLINGTON BLVD APT 1016
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2210
Mailing Address - Country:US
Mailing Address - Phone:216-903-9908
Mailing Address - Fax:
Practice Address - Street 1:6733 CURRAN ST STE 100
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6032
Practice Address - Country:US
Practice Address - Phone:703-448-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist