Healthcare Provider Details

I. General information

NPI: 1790334175
Provider Name (Legal Business Name): ELIZABETH VARGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S CARLIN SPRINGS RD STE 505
ARLINGTON VA
22204-1044
US

IV. Provider business mailing address

1011 ARLINGTON BLVD APT 1044
ARLINGTON VA
22209-2244
US

V. Phone/Fax

Practice location:
  • Phone: 703-620-5840
  • Fax: 703-820-5842
Mailing address:
  • Phone: 585-683-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305212836
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: