Provider Demographics
NPI:1346673787
Name:DOHOGNE, DESARAE NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:DESARAE
Middle Name:NICOLE
Last Name:DOHOGNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 SOUTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4208
Mailing Address - Country:US
Mailing Address - Phone:904-824-1478
Mailing Address - Fax:210-688-9228
Practice Address - Street 1:190 SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4208
Practice Address - Country:US
Practice Address - Phone:904-824-1478
Practice Address - Fax:210-688-9228
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232891225100000X
FLPT36344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist