Derek Tyler Wilson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

LPT-033905 Issued in AZ

Practice address

8410 W Thomas Rd Ste 136
Phoenix, AZ 85037-3374

Phone

(623) 247-4478

NPI assigned

Nov 25, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pritchette Physical TherapyGroup PAC ID 5193882124, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pritchette Physical Therapy

  • Physical Therapy Clinic/Center
  • Phoenix, AZ
  • NPI 1912144072
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1114743101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11528 S 53RD AVE",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853394523",
            "telephone_number": "480-559-4863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8410 W THOMAS RD STE 136",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850373374",
            "telephone_number": "623-247-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DEREK",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-033905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen Feeney Wilson, PSYD
• Corrie Wilson
• Danelle L Wilson, DO
• Deidre A Wilson, D.O.
• Demetrius Wilson
• Destiny Jeanette Wilson
• Donavan Wilson
• Elizabeth L Wilson, DO
• Emanuel James Wilson
• Felicia Wilson, PSY.D.

• Physical Therapist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.