Derrick Northrup, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1280 Issued in ID

Practice address

605 Taylor LN
Chubbuck, ID 83202-5169

Phone

(208) 221-6952

Fax

(844) 946-0909

NPI assigned

Dec 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Bloom Center for Pediatric Therapy, LLC

  • Speech-Language Pathologist
  • Pocatello, ID
  • NPI 1215397666

  ID, Physical Therapist

  Medicare reassignment NPD (past)
• Speech Therapy Services, LLC

  • Speech-Language Pathologist
  • Pocatello, ID
  • NPI 1669798971
  NPD (past)

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1124196340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 TAYLOR LN",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832025169",
            "telephone_number": "208-221-6952",
            "fax_number": "844-946-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 TAYLOR LN",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832025169",
            "telephone_number": "208-221-6952",
            "fax_number": "844-946-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORTHRUP",
        "first_name": "DERRICK",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT1280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805245100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "T6939",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Rabe Nevala, LPC
• Robert Newsom, RPH
• Arianna Lynn Nicolaysen, IBCLC
• Norco, Inc.
• Northrup Physical Therapy, PC
• Margo Northrup
• Megan Sanabia O'Brien
• Laila Ann Oakes, SLP
• Ashlynn Hayden Oborn, LMSW
• Shea Orr, PARAPROFESSIONAL

• All providers in Chubbuck, ID
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.