Doctor Name: | MR. JON ANTHONY DESMARAIS |
NPI Number: | 1619953221 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | 05006317A |
Business Practice Address: | 401 E Colfax Ave Ste. 102 South Bend, IN - 466172737 |
Business Phone Number: | 5742341059 |
Business Fax Number: | 5742341068 |
Mailing Address: | 401 E Colfax Ave, Ste. 102 SOUTH BEND |
State: | IN |
Postal Code: | 466172737 |
Phone Number: | 5742341059 |
Fax Number: | 5742341068 |
NPI Enumeration Date: | 12/16/2005 |
NPI Last Update Date: | 10/05/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 05006317A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
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 |