Provider Demographics
NPI:1972534063
Name:DAVID, DEREK T (PT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:T
Last Name:DAVID
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:417 GORDON CROCKET DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5162
Mailing Address - Country:US
Mailing Address - Phone:337-962-3461
Mailing Address - Fax:337-330-2024
Practice Address - Street 1:99 W MARTIAL AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6583
Practice Address - Country:US
Practice Address - Phone:337-962-3461
Practice Address - Fax:337-330-2024
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LALA01589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALA01589OtherLA STATE BOARD OF PHYSICAL THERAPIST