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NPI Code Detail

MEDICARE: LARA DE VARGAS PTA

MEDICARE: LARA DE VARGAS PTA
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
1225200000XPhysical Therapy Assistant014433AZ

General Provider Information

NPI Number : 1558123943
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA DE VARGAS PTA
Provider Business Mailing Address
First Line : 1778 W 10TH AVE
Second Line :
City : APACHE JUNCTION
State : AZ
Zip : 85120-6930
Country : US
Telephone Number : 714-402-4136
Fax Number :
Provider Business Practice Location Address
First Line : 4210 E BASELINE RD STE 106
Second Line :
City : MESA
State : AZ
Zip : 85206-4418
Country : US
Telephone Number : 480-503-2373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2024
Last Update Date : 01/30/2024

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Directions to “ LARA DE VARGAS PTA” Practice Location

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