Active NPI
Liji Annie Varghese, PHYSICAL THERAPIST
- Physical Therapist
- Chatsworth, CA
National Provider Identifier
1396482006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT300638
- Practice address
- 21343 Blackhawk St
Chatsworth, CA 91311-2311 - Phone
- (805) 328-7252
- NPI assigned
- May 14, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT300638 | CA | Primary |
Addresses
Primary practice location
21343 Blackhawk St
Chatsworth, CA 91311-2311
Mailing address
21343 Blackhawk St
Chatsworth, CA 91311-2311
Phone (805) 328-7252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241101000102 | CA | Practitioner - Physical Therapist in Private Practice | 2365975166 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT300638 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652486400000",
"number": "1396482006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21343 BLACKHAWK ST",
"city": "CHATSWORTH",
"state": "CA",
"postal_code": "913112311",
"telephone_number": "805-328-7252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21343 BLACKHAWK ST",
"city": "CHATSWORTH",
"state": "CA",
"postal_code": "913112311",
"telephone_number": "805-328-7252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARGHESE",
"first_name": "LIJI",
"middle_name": "ANNIE",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-14",
"last_updated": "2022-05-14",
"certification_date": "2022-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT300638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chatsworth, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.