Provider Demographics
NPI:1669652863
Name:ENTERIA, DEOGENES DE ASAS JR (PT)
Entity Type:Individual
Prefix:MR
First Name:DEOGENES
Middle Name:DE ASAS
Last Name:ENTERIA
Suffix:JR
Gender:M
Credentials:PT
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Mailing Address - Street 1:3290 NORTH RIDGE ROAD EXECUTIVE CENTER II
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3655
Mailing Address - Country:US
Mailing Address - Phone:410-750-9006
Mailing Address - Fax:
Practice Address - Street 1:3201 W. COMMERCIAL BLVD.
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT LAUDERDAXLE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-332-4445
Practice Address - Fax:954-332-4340
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
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Provider Licenses
StateLicense IDTaxonomies
PAPT018712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist