MEDICARE: MR. GENE ROGER DESMARTIN JR.

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	2251X0800X	Orthopedic Physical Therapist		FL

General Provider Information

NPI Number	:	1932533502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GENE ROGER DESMARTIN JR.

Provider Business Mailing Address
First Line	:	PO BOX 343
Second Line	:	17662 81ST RD
City	:	MC ALPIN
State	:	FL
Zip	:	32062-0343
Country	:	US
Telephone Number	:	407-450-3579
Fax Number	:

Provider Business Practice Location Address
First Line	:	17662 81ST RD
Second Line	:
City	:	MC ALPIN
State	:	FL
Zip	:	32062-0343
Country	:	US
Telephone Number	:	407-450-3579
Fax Number	:

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

Provider Enumeration Date	:	08/30/2013
Last Update Date	:	08/30/2013

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