Provider Demographics
NPI:1639289895
Name:DESCHENES, JANICE MARIE (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:MARIE
Last Name:DESCHENES
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 RIVER OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7878
Mailing Address - Country:US
Mailing Address - Phone:813-417-6832
Mailing Address - Fax:813-651-1700
Practice Address - Street 1:4621 RIVER OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7878
Practice Address - Country:US
Practice Address - Phone:813-417-6832
Practice Address - Fax:813-651-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 215392251G0304X
MA151242251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000412000Medicaid
FL889724700Medicaid