Provider Demographics
NPI:1023091584
Name:DESIMIO, JOHN THOMAS (LPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:DESIMIO
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 STONE HOLLOW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5631
Mailing Address - Country:US
Mailing Address - Phone:979-421-8500
Mailing Address - Fax:979-421-8283
Practice Address - Street 1:2505 STONE HOLLOW DR STE 200
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5631
Practice Address - Country:US
Practice Address - Phone:979-421-8500
Practice Address - Fax:979-421-8283
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026052225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation