MEDICARE: VARGO PHYSICAL THERAPY, INC.

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	18554	CA
2	225100000X	Physical Therapist	20196	CA

General Provider Information

NPI Number	:	1811910797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VARGO PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	25115 AVENUE STANFORD STE B135
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-1290
Country	:	US
Telephone Number	:	661-661-2509
Fax Number	:	661-250-9959

Provider Business Practice Location Address
First Line	:	19239 GOLDEN VALLEY RD
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91387
Country	:	US
Telephone Number	:	661-250-9890
Fax Number	:	661-250-9228

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT C GRIEDER
Credential	:
Telephone Number	:	818-889-2540

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	09/27/2018

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