Averi Derrick
Individual provider Active NPI Physical Therapist · College Station, TX
NPI 1396339248 · NPPES record last updated Dec 7, 2023
Key facts
- NPI
- 1396339248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1341830 (TX)
- Practice address
- 800 Scott and White Dr Ste 3.600
College Station, TX 77845-6440 - Phone
- (979) 207-4380
- NPI assigned
- Feb 22, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advance Therapy, PC
Practice addresses (Care Compare)
3700 Cross Park Dr
Bryan, TX 77802-4137
Phone (979) 774-9958
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210713001963 | TX | Practitioner - Physical Therapist in Private Practice | 6507268547 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1341830 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advance Therapy PC | Physical Therapist | Current |
Accepting new patients |
| Advance Therapy PC | Physical Therapist | Past |
Accepting new patients |
Locations
3700 Cross Park Dr
Bryan, TX 77802
Phone (979) 774-9958
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1341830 | TX | Yes |
Addresses
Primary practice location
800 Scott and White Dr Ste 3.600
College Station, TX 77845-6440
Mailing address
PO Box 844658
Dallas, TX 75284-4658
Phone (800) 994-0371
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | averi.derrick@bswhealth.org |
Other providers in College Station, TX
- Tahari Sephora Delvecchio
- Wendi L Denk
- Nicholas Tyler Dennie
- Dept of Assistive & Rehab Serv - Bryan Field Office
- Angela Ellis Derbes
- Ashley Desimone
- Jessica Dever
- Pooja Dhananjayan
- Alyssa Renee Diaz
- Kyle Russell Diblasi
All providers in College Station, TX · Physical Therapist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.