Healthcare Provider Details

I. General information

NPI: 1184450694
Provider Name (Legal Business Name): VARDEN VU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 HWY 290 E STE 140 BLDG 1
MANOR TX
78653
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 512-852-8004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1399615
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: