Provider Demographics
NPI:1467469577
Name:VARGAS, MICHAEL S (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 N NEW HOPE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4719
Mailing Address - Country:US
Mailing Address - Phone:704-869-8030
Mailing Address - Fax:704-869-0457
Practice Address - Street 1:365 N NEW HOPE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4719
Practice Address - Country:US
Practice Address - Phone:704-869-8030
Practice Address - Fax:704-869-0457
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist