MEDICARE: MR. DEREK C HARPER P.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A6387	LA

General Provider Information

NPI Number	:	1477885358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEREK C HARPER P.T.A.

Provider Business Mailing Address
First Line	:	1613 JIMMIE DAVIS HWY
Second Line	:	SUITE 400
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4557
Country	:	US
Telephone Number	:	318-423-3798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 JIMMIE DAVIS HIGHWAY
Second Line	:	SUITE 400
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4557
Country	:	US
Telephone Number	:	318-423-3798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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