Derek J Davidson, PTA
Individual provider Active NPI Physical Therapy Assistant · Chandler, TX
NPI 1225510639 · NPPES record last updated Aug 31, 2018
Key facts
- NPI
- 1225510639
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2087336 (TX)
- Practice address
- 300 Cherry St
Chandler, TX 75758-9636 - Phone
- (903) 849-2485
- NPI assigned
- Aug 31, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2087336 | TX | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2087336 | TX | Yes |
Addresses
Primary practice location
300 Cherry St
Chandler, TX 75758-9636
Mailing address
3961 County Road 1120
Tyler, TX 75704-7407
Phone (903) 752-4385
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2087336 | Medicaid | TX |
Other providers in Chandler, TX
- Karlie Lynn Cason
- Chandler Drug LLC
- Compassionate Hospice Care, Inc.
- Alisa Victoria Cook
- Darren Carnes
- Charles R. Dixon Jr.
- Shanna S Duke
- Sheri Kay Dunlap
- East Texas Recovery
- Etmc Physician Group Inc.
All providers in Chandler, TX · Physical Therapy Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.