Provider Demographics
NPI:1649248667
Name:VARGAS, ROMMEL CUETO (PT)
Entity type:Individual
Prefix:MR
First Name:ROMMEL
Middle Name:CUETO
Last Name:VARGAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2237
Mailing Address - Country:US
Mailing Address - Phone:516-495-4805
Mailing Address - Fax:
Practice Address - Street 1:64 HONEYSUCKLE ROAD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756
Practice Address - Country:US
Practice Address - Phone:516-495-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ15S01Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER