Provider Demographics
NPI:1154381895
Name:ATTARD, DERRICK J (MS, PT,)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:J
Last Name:ATTARD
Suffix:
Gender:M
Credentials:MS, PT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 71ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3013
Mailing Address - Country:US
Mailing Address - Phone:305-867-3925
Mailing Address - Fax:305-867-3927
Practice Address - Street 1:309 71ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3013
Practice Address - Country:US
Practice Address - Phone:305-867-3925
Practice Address - Fax:305-867-3927
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8736ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER