Provider Demographics
NPI:1750830774
Name:VARGHESE, RETTY (PT, DPT)
Entity type:Individual
Prefix:
First Name:RETTY
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 NADIA WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9990 RICHMOND AVE
Practice Address - Street 2:STE 201-S
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4559
Practice Address - Country:US
Practice Address - Phone:713-783-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1280955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist