Provider Demographics
NPI:1124674155
Name:DATHE, DEREK JOSEPH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JOSEPH
Last Name:DATHE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W 26TH ST RM 1200
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6863
Mailing Address - Country:US
Mailing Address - Phone:212-255-8080
Mailing Address - Fax:212-974-7228
Practice Address - Street 1:134 W 26TH ST RM 1200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6863
Practice Address - Country:US
Practice Address - Phone:212-255-8080
Practice Address - Fax:212-974-7228
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
NY047020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant