Provider Demographics
NPI:1972707149
Name:DEMOSS, PATRICK H (PT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:H
Last Name:DEMOSS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 ROYAL FOREST CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3124
Mailing Address - Country:US
Mailing Address - Phone:719-761-8393
Mailing Address - Fax:
Practice Address - Street 1:1583 ROYAL FOREST CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3124
Practice Address - Country:US
Practice Address - Phone:719-761-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06-6600Medicare ID - Type UnspecifiedPART A ID