MEDICARE: MERVIN DEGAMO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05008517A	IN

General Provider Information

NPI Number	:	1356593446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERVIN DEGAMO PT

Provider Business Mailing Address
First Line	:	118 MEDICAL DR
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-2923
Country	:	US
Telephone Number	:	317-573-1037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 E COUNTY LINE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0962
Country	:	US
Telephone Number	:	317-885-7050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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Directions to “ MERVIN DEGAMO PT” Practice Location

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