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General NPI Number Information
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NPI Number | 1659457158
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Entity Type | Organization
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Legal Business Name | DEREK ENTERPRISES LLC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 106 ROTARY DRIVE VALMONT INDUSTRIAL PARK
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City | W HAZLETON
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State | PA
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Zip | 18202
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Country | US
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Telephone | 570-459-6333
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Fax | 570-459-5255
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Provider Business Mailing Address
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Address Line | 1086 ROUTE 315
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City | PLAINS
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State | PA
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Zip | 18702
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Country | US
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Telephone | 570-823-7761
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Fax | 570-822-8033
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Authorized Official
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Title or Position | BUSINESS MGR TREAS
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Name | MR. DON R CASSETORI
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Credential |
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Telephone | 570-823-7761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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