Provider Demographics
NPI:1508255340
Name:VARGAS, KATHERINE L (PTA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16002 BRIDGER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8284
Mailing Address - Country:US
Mailing Address - Phone:406-586-0549
Mailing Address - Fax:
Practice Address - Street 1:321 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3415
Practice Address - Country:US
Practice Address - Phone:406-587-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant