Provider Demographics
NPI:1922394394
Name:DEGUMUZIO, DIANA (LMT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DEGUMUZIO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 SW 160TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-4294
Mailing Address - Country:US
Mailing Address - Phone:954-319-1225
Mailing Address - Fax:
Practice Address - Street 1:1844 SW 160TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-4294
Practice Address - Country:US
Practice Address - Phone:954-319-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist