Provider Demographics
NPI:1922176858
Name:DEGUZMAN-FOX, MARILOU AGAG (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MARILOU
Middle Name:AGAG
Last Name:DEGUZMAN-FOX
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:MARILOU
Other - Middle Name:AGAG
Other - Last Name:DEGUZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:10725 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7967
Mailing Address - Country:US
Mailing Address - Phone:916-631-2061
Mailing Address - Fax:
Practice Address - Street 1:10725 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7967
Practice Address - Country:US
Practice Address - Phone:916-631-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1680225100000X
CA18839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist