Individual provider Active NPI

Ann L Derrick, PT

  • Physical Therapist
  • Peoria, AZ
National Provider Identifier
1205977014
Registry record updated Nov 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5169 Issued in AZ
Practice address
9559 W Pinnacle Vista Dr
Peoria, AZ 85383-8715
Phone
(623) 980-2844
Fax
(623) 505-9755
NPI assigned
Feb 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5169 AZ Primary

Addresses

Primary practice location

9559 W Pinnacle Vista Dr
Peoria, AZ 85383-8715

Mailing address

24654 N Lake Pleasant Pkwy
Peoria, AZ 85383-1359
Phone (602) 679-5050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040902000126 AZ Practitioner - Physical Therapist in Private Practice 9830164003 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5169AZMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rhad Academy and Healthcare Current Accepting new patients
Rhad Health Care LLC CurrentSince Sep 1, 2022 Accepting new patients
Elite Assisted Living Home Current Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700697600000",
    "number": "1205977014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24654 N LAKE PLEASANT PKWY",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853831359",
            "telephone_number": "602-679-5050",
            "fax_number": "623-505-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9559 W PINNACLE VISTA DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853838715",
            "telephone_number": "623-980-2844",
            "fax_number": "623-505-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "ANN",
        "middle_name": "L",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2023-11-23",
        "certification_date": "2023-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "5169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2023; 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.