Healthcare Provider Details

I. General information

NPI: 1831558139
Provider Name (Legal Business Name): DEREK MANSFIELD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PALISADE ST STE 217
DOBBS FERRY NY
10522-1617
US

IV. Provider business mailing address

40 COLONIAL AVE
DOBBS FERRY NY
10522-2902
US

V. Phone/Fax

Practice location:
  • Phone: 914-222-0876
  • Fax: 347-713-7748
Mailing address:
  • Phone: 914-222-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number018934
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number018-934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: