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NPI Code Detail

MEDICARE: DERRICK RICHARD TORRES PT

MEDICARE: DERRICK RICHARD TORRES 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
1225200000XPhysical Therapy AssistantPTA000005981TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14004523OTHERTNBCBST
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972987139
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK RICHARD TORRES PT
Provider Business Mailing Address
First Line : 80 SOUTH PRESCOTT STREET
Second Line : MOMENTUM PHYSICAL REHABILITATION, LLC
City : MEMPHIS
State : TN
Zip : 38111-4635
Country : US
Telephone Number : 901-257-3422
Fax Number : 901-257-3423
Provider Business Practice Location Address
First Line : 80 SOUTH PRESCOTT STREET
Second Line : MOMENTUM PHYSICAL REHABILITATION, LLC
City : MEMPHIS
State : TN
Zip : 38111-4635
Country : US
Telephone Number : 901-257-3422
Fax Number : 901-257-3423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2015
Last Update Date : 07/16/2015

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Directions to “ DERRICK RICHARD TORRES PT” Practice Location

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