Active NPI
Derek B Charles, D.P.T.
- Physical Therapist
- Mt Juliet, TN
National Provider Identifier
1619084571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7419
- Practice address
- 5002 Crossings Cir
Mt Juliet, TN 37122-8419 - Phone
- (615) 553-5500
- Fax
- (615) 758-3875
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7419 | TN | Primary |
Addresses
Primary practice location
5002 Crossings Cir
Mt Juliet, TN 37122-8419
Mailing address
5002 Crossings Cir
Mt Juliet, TN 37122-8419
Phone (615) 553-5500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7419 | Other | TN | LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619084571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5002 CROSSINGS CIR",
"city": "MT JULIET",
"state": "TN",
"postal_code": "371228419",
"telephone_number": "615-553-5500",
"fax_number": "615-758-3875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5002 CROSSINGS CIR",
"city": "MT JULIET",
"state": "TN",
"postal_code": "371228419",
"telephone_number": "615-553-5500",
"fax_number": "615-758-3875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLES",
"first_name": "DEREK",
"middle_name": "B",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "7419",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "7419",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mt Juliet, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.