Provider Demographics
NPI:1922589399
Name:VARGO, AMANDA (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:VARGO
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 1:408 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-1318
Mailing Address - Country:US
Mailing Address - Phone:412-260-0422
Mailing Address - Fax:
Practice Address - Street 1:1550 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2104
Practice Address - Country:US
Practice Address - Phone:585-671-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist