Provider Demographics
NPI:1659619070
Name:VARGAS, VICTOR ENRIQUE JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:ENRIQUE
Last Name:VARGAS
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6523
Mailing Address - Country:US
Mailing Address - Phone:352-589-5595
Mailing Address - Fax:352-589-5747
Practice Address - Street 1:443 PLAZA DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6523
Practice Address - Country:US
Practice Address - Phone:352-589-5595
Practice Address - Fax:352-589-5747
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 23518225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686675Medicare PIN