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NPI Code Detail

MEDICARE: DEREK BEHLOW PT, DPT

MEDICARE: DEREK BEHLOW PT, 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
1225100000XPhysical Therapist5501019490MI

General Provider Information

NPI Number : 1598396194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK BEHLOW PT, DPT
Provider Business Mailing Address
First Line : 40776 NOBLETON DR
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-6926
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2558 N SQUIRREL RD
Second Line :
City : AUBURN HILLS
State : MI
Zip : 48326-2383
Country : US
Telephone Number : 248-340-1100
Fax Number : 248-340-1101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2020
Last Update Date : 02/01/2020

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