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General NPI Number Information
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NPI Number | 1851634521
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Entity Type | Individual
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Provider Name | DEREK A WILLIS DPT
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Gender | Male
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 20 TROTTING DR
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City | CHESTER
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State | NY
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Zip | 10918-1120
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Country | US
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Telephone | 457-425-1218
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Fax |
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Provider Business Mailing Address
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Address Line | 271 GRAND ST
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City | NEW YORK
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State | NY
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Zip | 10002-4464
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Country | US
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Telephone | 464-768-3006
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Fax |
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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 | 40QA01490500
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License Number State | NJ
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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 | 036045
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License Number State | NY
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