Active NPI
Mark Derouaux, PT
- Physical Therapist
- Ormond Beach, FL
National Provider Identifier
1689708026
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 14735
- Practice address
- 535 N Nova Rd
Ormond Beach, FL 32174-4405 - Phone
- (386) 673-1809
- Fax
- (386) 673-3998
- NPI assigned
- Mar 16, 2007
- 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 | 14735 | FL | Primary |
Addresses
Primary practice location
535 N Nova Rd
Ormond Beach, FL 32174-4405
Mailing address
1 Tomoka Oaks Blvd
#134
Ormond Beach, FL 32174-3801
Phone (386) 673-1809
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14735 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221523200000",
"number": "1689708026",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 TOMOKA OAKS BLVD",
"address_2": "#134",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321743801",
"telephone_number": "386-673-1809",
"fax_number": "386-673-3998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 N NOVA RD",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321744405",
"telephone_number": "386-673-1809",
"fax_number": "386-673-3998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROUAUX",
"first_name": "MARK",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2008-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "14735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ormond Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.