Provider Demographics
NPI:1366620221
Name:DESRAVINS, JEAN HERBY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:HERBY
Last Name:DESRAVINS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7627 OLD THYME CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3904
Mailing Address - Country:US
Mailing Address - Phone:954-558-1786
Mailing Address - Fax:
Practice Address - Street 1:7627 OLD THYME CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3904
Practice Address - Country:US
Practice Address - Phone:954-558-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-03
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist