Provider Demographics
NPI:1760018113
Name:DEMYANOVICH, DEVIN (ATC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:DEMYANOVICH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 COZART ST UNIT 217
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-6219
Mailing Address - Country:US
Mailing Address - Phone:570-778-6385
Mailing Address - Fax:
Practice Address - Street 1:110 WHITFORD DRIVE WD MURRAY BUILDING RM 212
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27708-0001
Practice Address - Country:US
Practice Address - Phone:919-668-5626
Practice Address - Fax:919-684-9981
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-17122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer