Active NPI
Dexter De Guzman Decano, P.T.
- Physical Therapist
- Lawton, OK
National Provider Identifier
1649413865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4051
- Practice address
- 1401 SW Parkridge Blvd
Suite a
Lawton, OK 73505-7575 - Phone
- (580) 248-5668
- Fax
- (580) 248-0785
- NPI assigned
- Apr 17, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4051 | OK | Primary |
Addresses
Primary practice location
1401 SW Parkridge Blvd
Suite a
Lawton, OK 73505-7575
Mailing address
1401 SW Parkridge Blvd
Suite a
Lawton, OK 73505-7575
Phone (580) 248-5668
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4051 | OK | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239926400000",
"number": "1649413865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 SW PARKRIDGE BLVD",
"address_2": "SUITE A",
"city": "LAWTON",
"state": "OK",
"postal_code": "735057575",
"telephone_number": "580-248-5668",
"fax_number": "580-248-0785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 SW PARKRIDGE BLVD",
"address_2": "SUITE A",
"city": "LAWTON",
"state": "OK",
"postal_code": "735057575",
"telephone_number": "580-248-5668",
"fax_number": "580-248-0785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECANO",
"first_name": "DEXTER",
"middle_name": "DE GUZMAN",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-17",
"last_updated": "2009-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "4051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.