MEDICARE: DEREK THIEMS DPT

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	225100000X	Physical Therapist	05013082A	IN

General Provider Information

NPI Number	:	1538851373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK THIEMS DPT

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:	317-621-7547
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 BROAD RIPPLE AVE
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2002
Country	:	US
Telephone Number	:	317-621-3680
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/31/2023

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