Provider Demographics
NPI:1811910797
Name:VARGO PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:VARGO PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-889-2540
Mailing Address - Street 1:25115 AVENUE STANFORD STE B135
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1290
Mailing Address - Country:US
Mailing Address - Phone:661-661-2509
Mailing Address - Fax:661-250-9959
Practice Address - Street 1:19239 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387
Practice Address - Country:US
Practice Address - Phone:661-250-9890
Practice Address - Fax:661-250-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18554225100000X
CA20196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15002Medicare ID - Type Unspecified
CAW15002AMedicare ID - Type Unspecified
CAW15002DMedicare ID - Type Unspecified
CAW15002BMedicare ID - Type Unspecified
CAW15002EMedicare ID - Type Unspecified