Provider Demographics
NPI:1831310812
Name:VARGHESE, REEBA (PT)
Entity Type:Individual
Prefix:
First Name:REEBA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2007
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:600 HEALTH PARK BLVD
Practice Address - Street 2:STE C
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2556
Practice Address - Country:US
Practice Address - Phone:810-603-8300
Practice Address - Fax:810-603-8305
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP45540006Medicare PIN
MIP45530006Medicare PIN