Provider Demographics
NPI:1053351288
Name:DEGUZMAN, THOMAS VICTOR (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:VICTOR
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 E BADILLO ST
Mailing Address - Street 2:MLB 309
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2950
Mailing Address - Country:US
Mailing Address - Phone:626-576-5757
Mailing Address - Fax:626-576-5760
Practice Address - Street 1:931 BUENA VISTA ST
Practice Address - Street 2:SUITE 304
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1712
Practice Address - Country:US
Practice Address - Phone:626-389-0187
Practice Address - Fax:626-956-0770
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist