Susan Varghese Mammen

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

36259 Issued in CA

Practice address

22 Odyssey
#165
Irvine, CA 92618-3186

Phone

(949) 727-2192

NPI assigned

Jan 6, 2010

Last updated

May 19, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Susan Varghese Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305763200000",
    "number": "1164752564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 ODYSSEY",
            "address_2": "#165",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183186",
            "telephone_number": "949-727-2192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 ODYSSEY",
            "address_2": "#165",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183186",
            "telephone_number": "949-727-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMMEN",
        "first_name": "SUSAN",
        "middle_name": "VARGHESE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-06",
        "last_updated": "2011-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "36259",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "62-027654",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "VARGHESE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Tyler James Maly, M.D.
• Manal Aziz DDS Inc (family dental care group)
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• Brian Manas, D.C.
• Laura Corinne Mandich, PT, DPT
• Fatima Manesh, ALC

• Physical Therapist in Irvine, CA
• Providers in Irvine, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.