Provider Demographics
NPI:1598846255
Name:DEGARMO, MICHELE PATRICIA (MPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:PATRICIA
Last Name:DEGARMO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5128
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:70 JEFFERSON CT STE 102
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-9604
Practice Address - Country:US
Practice Address - Phone:540-832-3061
Practice Address - Fax:540-832-3062
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10748225100000X
VA2305004574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2729079Medicaid
OH2729079Medicaid