Provider Demographics
NPI:1659597649
Name:VARELA, RALPH (PT)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:VARELA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 JEWELFISH CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-4392
Mailing Address - Country:US
Mailing Address - Phone:512-388-1784
Mailing Address - Fax:
Practice Address - Street 1:8403 CROSS PARK DR
Practice Address - Street 2:SUITE 1F
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-4539
Practice Address - Country:US
Practice Address - Phone:512-833-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11398972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic