Provider Demographics
NPI:1932533502
Name:DESMARTIN, GENE ROGER JR
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:ROGER
Last Name:DESMARTIN
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:PO BOX 343
Mailing Address - Street 2:17662 81ST RD
Mailing Address - City:MC ALPIN
Mailing Address - State:FL
Mailing Address - Zip Code:32062-0343
Mailing Address - Country:US
Mailing Address - Phone:407-450-3579
Mailing Address - Fax:
Practice Address - Street 1:17662 81ST RD
Practice Address - Street 2:
Practice Address - City:MC ALPIN
Practice Address - State:FL
Practice Address - Zip Code:32062-0343
Practice Address - Country:US
Practice Address - Phone:407-450-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic