Healthcare Provider Details

I. General information

NPI: 1720343015
Provider Name (Legal Business Name): DEREK ALEXANDER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5833 W I-20
ARLINGTON TX
76017-1057
US

IV. Provider business mailing address

5833 W I-20
ARLINGTON TX
76017-1057
US

V. Phone/Fax

Practice location:
  • Phone: 817-516-1115
  • Fax: 817-516-1104
Mailing address:
  • Phone: 817-516-1115
  • Fax: 817-516-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1218497
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: