Provider Demographics
NPI:1912999202
Name:DEMAYO, PANFILO DEMAGAJES JR
Entity Type:Individual
Prefix:MR
First Name:PANFILO
Middle Name:DEMAGAJES
Last Name:DEMAYO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8448 PINE CONE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-7713
Mailing Address - Country:US
Mailing Address - Phone:850-877-9839
Mailing Address - Fax:
Practice Address - Street 1:132 SALEM CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2810
Practice Address - Country:US
Practice Address - Phone:850-877-8177
Practice Address - Fax:850-656-3463
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 9041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y043COtherBCBS FL
00724OtherUNIVERSAL HEALTHCARE
00724OtherUNIVERSAL HEALTHCARE