Healthcare Provider Details

I. General information

NPI: 1538086525
Provider Name (Legal Business Name): KEVIN DEGNAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 VALLEY RD
GILLETTE NJ
07933-2012
US

IV. Provider business mailing address

644 VALLEY RD
GILLETTE NJ
07933-2012
US

V. Phone/Fax

Practice location:
  • Phone: 908-991-3761
  • Fax: 908-991-3770
Mailing address:
  • Phone: 908-991-3761
  • Fax: 908-991-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02427300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: