MEDICARE: MR. DERECK B HOPE P.T.

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

General Provider Information

NPI Number	:	1881639540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DERECK B HOPE P.T.

Provider Business Mailing Address
First Line	:	1551 RENAISSANCE TOWNE DR STE 350
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-7674
Country	:	US
Telephone Number	:	801-295-3553
Fax Number	:	801-295-3599

Provider Business Practice Location Address
First Line	:	1266 LEGEND HILLS DR
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-2274
Country	:	US
Telephone Number	:	801-776-6000
Fax Number	:	801-776-1166

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	01/04/2018

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