Provider Demographics
NPI:1972987139
Name:TORRES, DERRICK RICHARD (PT)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:RICHARD
Last Name:TORRES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SOUTH PRESCOTT STREET
Mailing Address - Street 2:MOMENTUM PHYSICAL REHABILITATION, LLC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4635
Mailing Address - Country:US
Mailing Address - Phone:901-257-3422
Mailing Address - Fax:901-257-3423
Practice Address - Street 1:80 SOUTH PRESCOTT STREET
Practice Address - Street 2:MOMENTUM PHYSICAL REHABILITATION, LLC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4635
Practice Address - Country:US
Practice Address - Phone:901-257-3422
Practice Address - Fax:901-257-3423
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA000005981225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4004523OtherBCBST
TN0446657Medicaid
TN446657Medicare Oscar/Certification