Provider Demographics
NPI:1982670394
Name:VARGHESE, JYOTHI S
Entity Type:Individual
Prefix:MRS
First Name:JYOTHI
Middle Name:S
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JYOTHI
Other - Middle Name:S
Other - Last Name:KUNNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42992 MARBURG TER
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6013
Mailing Address - Country:US
Mailing Address - Phone:201-696-2085
Mailing Address - Fax:
Practice Address - Street 1:42992 MARBURG TER
Practice Address - Street 2:
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-6013
Practice Address - Country:US
Practice Address - Phone:201-696-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21225225100000X
VA2305209299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist