Provider Demographics
NPI:1083706642
Name:DEGARMO, MARK E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:DEGARMO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 PRESIDENTIAL PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7268
Mailing Address - Country:US
Mailing Address - Phone:614-791-0702
Mailing Address - Fax:614-791-0702
Practice Address - Street 1:3967 PRESIDENTIAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7268
Practice Address - Country:US
Practice Address - Phone:614-791-0702
Practice Address - Fax:614-791-0702
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2706183Medicaid
OH2706183Medicaid