Healthcare Provider Details

I. General information

NPI: 1740521350
Provider Name (Legal Business Name): TIMOTHY VARGHESE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 HAYWOOD RD
GREENVILLE SC
29607-3422
US

IV. Provider business mailing address

204 LOWNDES AVE
GREENVILLE SC
29607-1434
US

V. Phone/Fax

Practice location:
  • Phone: 864-558-7346
  • Fax:
Mailing address:
  • Phone: 864-558-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7057
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7057
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: