MEDICARE: MR. BLESSON VARGHESE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1477192904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BLESSON VARGHESE

Provider Business Mailing Address
First Line	:	842 W PANORAMA DR APT 211
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-2154
Country	:	US
Telephone Number	:	224-805-9690
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD STE 306
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1452
Country	:	US
Telephone Number	:	224-805-9690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2020
Last Update Date	:	01/01/2020

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