MEDICARE: MR. DEREK LAM PT, DPT, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1248689	TX
2	2251S0007X	Sports Physical Therapist	1248689	TX
3	2251X0800X	Orthopedic Physical Therapist	1248689	TX

General Provider Information

NPI Number	:	1093183980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEREK LAM PT, DPT, CSCS

Provider Business Mailing Address
First Line	:	12539 PERRY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5038
Country	:	US
Telephone Number	:	281-890-7539
Fax Number	:

Provider Business Practice Location Address
First Line	:	12539 PERRY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5038
Country	:	US
Telephone Number	:	281-890-7539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	09/09/2015

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