Provider Demographics
NPI:1205903861
Name:DEASON INC
Entity type:Organization
Organization Name:DEASON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:DEASON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:619-660-8895
Mailing Address - Street 1:3515 SWEETWATER SPRINGS BLVD
Mailing Address - Street 2:#9
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978
Mailing Address - Country:US
Mailing Address - Phone:619-660-8895
Mailing Address - Fax:619-660-8697
Practice Address - Street 1:3515 SWEETWATER SPRINGS BLVD
Practice Address - Street 2:#9
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978
Practice Address - Country:US
Practice Address - Phone:619-660-8895
Practice Address - Fax:619-660-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15875Medicare ID - Type Unspecified