Healthcare Provider Details

I. General information

NPI: 1235694704
Provider Name (Legal Business Name): JOHN SAVEL DEGUZMAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 US 1 HWY
YOUNGSVILLE NC
27596-9219
US

IV. Provider business mailing address

1620 US 1 HWY
YOUNGSVILLE NC
27596-9219
US

V. Phone/Fax

Practice location:
  • Phone: 984-237-0096
  • Fax: 800-877-3496
Mailing address:
  • Phone: 984-237-0096
  • Fax: 800-877-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA8909
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: