Provider Demographics
NPI:1528150059
Name:ANDREWS, DEREK MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:MICHAEL
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HEALTHCARE DR
Mailing Address - Street 2:MANSFIELD HILL
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-9406
Mailing Address - Country:US
Mailing Address - Phone:304-457-1760
Mailing Address - Fax:304-457-1516
Practice Address - Street 1:6 HEALTHCARE DR
Practice Address - Street 2:MANSFIELD HILL
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-9406
Practice Address - Country:US
Practice Address - Phone:304-457-1760
Practice Address - Fax:304-457-1516
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1976OtherPT LICENSE