Healthcare Provider Details

I. General information

NPI: 1659457158
Provider Name (Legal Business Name): DEREK ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ROTARY DRIVE VALMONT INDUSTRIAL PARK
W HAZLETON PA
18202
US

IV. Provider business mailing address

1086 ROUTE 315
PLAINS PA
18702
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-6333
  • Fax: 570-459-5255
Mailing address:
  • Phone: 570-823-7761
  • Fax: 570-822-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DON R CASSETORI
Title or Position: BUSINESS MGR TREAS
Credential:
Phone: 570-823-7761