Provider Demographics
NPI:1477192904
Name:VARGHESE, BLESSON
Entity type:Individual
Prefix:MR
First Name:BLESSON
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 W PANORAMA DR APT 211
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2154
Mailing Address - Country:US
Mailing Address - Phone:224-805-9690
Mailing Address - Fax:
Practice Address - Street 1:1535 LAKE COOK RD STE 306
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1452
Practice Address - Country:US
Practice Address - Phone:224-805-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist