Provider Demographics
NPI:1255096368
Name:DEGUILLA, CHRISTOPHER C (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:DEGUILLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NEIL CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5815
Mailing Address - Country:US
Mailing Address - Phone:516-766-0505
Mailing Address - Fax:516-766-0680
Practice Address - Street 1:309 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3241
Practice Address - Country:US
Practice Address - Phone:516-568-7858
Practice Address - Fax:516-766-0680
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047860-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist