Polaris Rehabilitation, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

POLARIS REHABILITATION, LLC

Practice address

1620 US 1 Hwy
Youngsville, NC 27596-9219

Phone

(984) 237-0096

Fax

(800) 877-3496

NPI assigned

Mar 1, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Deguzman, C.PEDNPI 1235694704

Title

Organizer/Member

Phone

(630) 362-0029

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alma Deguzman, LPT, C.PED

  • Physical Therapist
  • Youngsville, NC
  • NPI 1750314910
  Medicare reassignment NPD
• John Savel Deguzman, PTA

  • Physical Therapy Assistant
  • Youngsville, NC
  • NPI 1235694704
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1114467701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2208 RAINY LAKE ST",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275873423",
            "telephone_number": "630-362-0029",
            "fax_number": "800-877-3496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 US 1 HWY",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275969219",
            "telephone_number": "984-237-0096",
            "fax_number": "800-877-3496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLARIS REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-01",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "DEGUZMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ORGANIZER/MEMBER",
        "authorized_official_telephone_number": "630-362-0029",
        "authorized_official_credential": "C.PED"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P10385",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Pegram, LCSWA
• Tyrese Leon Perry
• Angela Phan, MA, LPA
• Dan M Phillips, MD
• Tanya Donnella Pleasent
• Powerful Purpose Psychological & Support Services PLLC
• Primus Home Health Solutions LLC
• Private Diagnostic Clinic, PLLC
• Hannah Proctor, MA, CCC/SLP
• Jaclyn S Qualter, NP

• Prosthetic/Orthotic Supplier in Youngsville, NC
• Providers in Youngsville, NC by specialty
• Prosthetic/Orthotic Supplier in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.