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NPI Code Detail

MEDICARE: DEREK CHIU PT

MEDICARE: DEREK CHIU PT
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 Therapist295163CA

General Provider Information

NPI Number : 1770064123
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK CHIU PT
Provider Business Mailing Address
First Line : 5557 CORALWOOD PL
Second Line :
City : FONTANA
State : CA
Zip : 92336-5900
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3200 INLAND EMPIRE BLVD STE 100
Second Line :
City : ONTARIO
State : CA
Zip : 91764-5569
Country : US
Telephone Number : 909-945-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2018
Last Update Date : 08/23/2018

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