Brandon Edward Derouchie, DPT

Key facts

NPI

1336869742

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

P23351 (NC)

Practice address

17751 Murdock Cir
Port Charlotte, FL 33948-1034

Phone

(941) 743-8700

Fax

(941) 743-8850

NPI assigned

Aug 29, 2022

Sex

Male

Sole proprietor

No

Organizations & group practices 10

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.

• Agilitas USA Inc Physical Therapy Clinic/Center · Hixson, TN · NPI 1962417444
  Medicare reassignment NPD NC · PHYSICAL THERAPIST
• Benchmark Physical Therapy of North Carolina LLC Physical Therapist · Ooltewah, TN · NPI 1356894604
  Medicare reassignment NPD NC · PHYSICAL THERAPIST
• Drayer Physical Therapy of North Carolina LLC Physical Therapist · Raleigh, NC · NPI 1740605096
  Medicare reassignment NPD NC · PHYSICAL THERAPIST
• Physical Therapy and Hand Specialists, LLC Physical Therapist · Greensboro, NC · NPI 1518382357
  Medicare reassignment NPD NC · PHYSICAL THERAPIST
• Douglass Orthopedic & Spine Rehabilitation, Inc. Physical Therapist · Bonita Springs, FL · NPI 1992762298
  NPD PHYSICAL THERAPIST
• Fyzbiz, LLC Rehabilitation Clinic/Center · Fort Myers, FL · NPI 1700248887
  NPD PHYSICAL THERAPIST
• Progressive Physical Therapy Service Inc. Orthopedic Physical Therapist · Port Charlotte, FL · NPI 1043261233
  NPD PHYSICAL THERAPIST
• Agilitas USA, Inc Physical Therapy Clinic/Center · Chattanooga, TN · NPI 1518695436
  NPD PHYSICAL THERAPIST
• Benchmark Physical Therapy of NC, LLC Physical Therapist · Leland, NC · NPI 1588189112
  NPD PHYSICAL THERAPIST
• Physical Therapy and Hand Specialist, LLC Physical Therapy Clinic/Center · Reidsville, NC · NPI 1205251964
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NC

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 5, 2024.

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1336869742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25241 ELEMENTARY WAY STE 200",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341357883",
            "telephone_number": "239-947-4184",
            "fax_number": "239-947-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17751 MURDOCK CIR",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481034",
            "telephone_number": "941-743-8700",
            "fax_number": "941-743-8850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5393 S Calle Santa Cruz Ste 107",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857063556",
            "country_code": "US",
            "telephone_number": "520-225-0129",
            "fax_number": "520-244-0000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6711 Towpath Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "East Syracuse",
            "state": "NY",
            "postal_code": "130579509",
            "country_code": "US",
            "telephone_number": "315-637-4747",
            "fax_number": "315-637-6711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEROUCHIE",
        "first_name": "BRANDON",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-29",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT41183",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "049257-01",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P23351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

• Robin G Deo, PT
• Rhona Holganza Depaul, M.D.
• April Depombo, DO
• Shelley Dereu, LCSW
• Dermatology Group of Florida PA
• Kevin J Desantis, MD
• Natalie Suzanne Desantis, APRN
• Diane Marie Desilets, OTR/L
• Brittany Lukeyanna Desyr, DMD
• Pallavi Ravi Devaguptapu, O.T

All providers in Port Charlotte, FL · Physical Therapist in Florida