Provider Demographics
NPI:1407176324
Name:VARGAS, LUCELLY (PT)
Entity Type:Individual
Prefix:MRS
First Name:LUCELLY
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 1:1411 SAINT GABRIELLE LN
Mailing Address - Street 2:# 35-02
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-4034
Mailing Address - Country:US
Mailing Address - Phone:954-274-7061
Mailing Address - Fax:954-218-5366
Practice Address - Street 1:1411 SAINT GABRIELLE LN
Practice Address - Street 2:# 35-02
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4034
Practice Address - Country:US
Practice Address - Phone:954-274-7061
Practice Address - Fax:954-218-5366
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist