Healthcare Provider Details

I. General information

NPI: 1639289895
Provider Name (Legal Business Name): JANICE MARIE DESCHENES MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 RIVER OVERLOOK DR
VALRICO FL
33596-7878
US

IV. Provider business mailing address

4621 RIVER OVERLOOK DR
VALRICO FL
33596-7878
US

V. Phone/Fax

Practice location:
  • Phone: 813-417-6832
  • Fax: 813-651-1700
Mailing address:
  • Phone: 813-417-6832
  • Fax: 813-651-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT 21539
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number15124
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: