Provider Demographics
NPI:1497706634
Name:OLIVE N DEGUZMAN RPT PA
Entity Type:Organization
Organization Name:OLIVE N DEGUZMAN RPT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR OF REHAB
Authorized Official - Prefix:MRS
Authorized Official - First Name:MA OLIVIA
Authorized Official - Middle Name:NAJARRO
Authorized Official - Last Name:DEGUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-629-5288
Mailing Address - Street 1:4054 BEAVER LN
Mailing Address - Street 2:SUITE 1-2
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9296
Mailing Address - Country:US
Mailing Address - Phone:941-629-5288
Mailing Address - Fax:
Practice Address - Street 1:4054 BEAVER LN
Practice Address - Street 2:SUITE 1-2
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9296
Practice Address - Country:US
Practice Address - Phone:941-629-5288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8615OtherBLUE CROSS BLUE SHEILD
FLY8615OtherBLUE CROSS BLUE SHEILD
FLY8615ZMedicare PIN