Provider Demographics
NPI:1497056584
Name:VARGHESE, SUSAN W (DPT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:W
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E COMMERCIAL BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3769
Mailing Address - Country:US
Mailing Address - Phone:954-323-4484
Mailing Address - Fax:
Practice Address - Street 1:2021 E COMMERCIAL BLVD STE 308
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3769
Practice Address - Country:US
Practice Address - Phone:954-323-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37033225100000X
FLPT24437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT24437OtherPHYSICAL THERAPY BOARD OF FLORIDA
CAPT37033OtherPHYSICAL THERAPY BOARD OF CALIFORNIA