| Doctor Name: | MR. MARK DEJONG |
| NPI Number: | 1043335607 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PT33493 |
| Business Practice Address: | 1191 E Yosemite Ave Ste A Manteca, CA - 953365011 |
| Business Phone Number: | 2098249888 |
| Business Fax Number: | 2098249469 |
| Mailing Address: | 220 Standiford Ave, Ste F MODESTO |
| State: | CA |
| Postal Code: | 953501159 |
| Phone Number: | 2095795628 |
| Fax Number: | 2095795637 |
| NPI Enumeration Date: | 03/20/2007 |
| NPI Last Update Date: | 03/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT33493 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |