Provider Demographics
NPI:1962926162
Name:KIRIMA, DERRICK B
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:B
Last Name:KIRIMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WINKEL CT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2170
Mailing Address - Country:US
Mailing Address - Phone:443-266-8481
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:800-879-4471
Practice Address - Fax:800-493-3400
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2022-07-28
Deactivation Date:2020-05-07
Deactivation Code:
Reactivation Date:2022-07-28
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0001166225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant