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General NPI Number Information
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NPI Number | 1205977014
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Entity Type | Individual
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Provider Name | ANN L DERRICK PT
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 11/23/2023
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Provider Practice Location Address
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Address Line | 9559 W PINNACLE VISTA DR
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City | PEORIA
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State | AZ
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Zip | 85383-8715
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Country | US
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Telephone | 623-980-2844
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Fax | 623-505-9755
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Provider Business Mailing Address
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Address Line | 24654 N LAKE PLEASANT PKWY
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City | PEORIA
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State | AZ
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Zip | 85383-1359
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Country | US
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Telephone | 602-679-5050
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Fax | 623-505-9755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5169
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License Number State | AZ
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