Individual provider Active NPI

Deyoung Don, PT, DPT

  • Physical Therapist
  • St Augustine, FL
National Provider Identifier
1144995325
Registry record updated Jun 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT37456 Issued in FL
Practice address
425 W Town PL Ste 102
St Augustine, FL 32092-3662
Phone
(904) 292-0195
Fax
(904) 292-0566
NPI assigned
Aug 10, 2021
Last updated
Jun 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT37456 FL Primary

Addresses

Primary practice location

425 W Town PL Ste 102
St Augustine, FL 32092-3662

Mailing address

376 Brookgreen Way
St Augustine, FL 32092-3368
Phone (908) 370-2715

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220203001911 FL Practitioner - Physical Therapist in Private Practice 0547653198 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlas Physical Therapy and Sports Medicine IncGroup PAC ID 8426017807, 11 clinicians

Practice addresses (Care Compare)

425 W Town PL
Suite 102
St Augustine, FL 32092-3662
Phone (904) 342-4994

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT37456FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Atlas Physical Therapy & Sports Medicine Inc Physical Therapist CurrentSince Jan 17, 2022 Accepting new patients
Atlas Physical Therapy & Sports Medicine Inc Physical Therapist CurrentSince Jan 17, 2022 Accepting new patients

Locations

12421 San Jose Blvd
Ste 100
Jacksonville, FL 32223
Phone (904) 292-0195

425 W Town Pl
Ste 102
St Augustine, FL 32092
Phone (904) 292-0195

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717286400000",
    "number": "1144995325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "376 BROOKGREEN WAY",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923368",
            "telephone_number": "908-370-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W TOWN PL STE 102",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923662",
            "telephone_number": "904-292-0195",
            "fax_number": "904-292-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DON",
        "first_name": "DEYOUNG",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-10",
        "last_updated": "2024-06-02",
        "certification_date": "2024-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT37456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.