Healthcare Provider Details

I. General information

NPI: 1407762909
Provider Name (Legal Business Name): DERRICK ACOSTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 WELLNESS AVE STE 100
ORANGE CITY FL
32763-8335
US

IV. Provider business mailing address

8206 STONEBROOK DR
SANFORD FL
32773-4994
US

V. Phone/Fax

Practice location:
  • Phone: 386-575-4027
  • Fax:
Mailing address:
  • Phone: 915-929-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA34934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: