Derek Bullen
Individual provider Active NPI Physical Therapy Assistant · Heathrow, FL
NPI 1710213772 · NPPES record last updated Oct 27, 2009
Key facts
- NPI
- 1710213772
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 3901 (TN)
- Practice address
- 1485 International Pkwy
Heathrow, FL 32746-5303 - Phone
- (800) 798-6035
- NPI assigned
- Oct 27, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 3901 | TN | Yes |
Addresses
Primary practice location
1485 International Pkwy
Heathrow, FL 32746-5303
Mailing address
1485 International Pkwy
Heathrow, FL 32746-5303
Phone (800) 798-6035
Other providers in Heathrow, FL
- Scott Earl Brewer
- Danette Brimigion
- Christal Brown
- Brenda Kay Bryant
- Leslie Buckner
- Patricia Burbank
- Michael Eugene Burton
- Terri Caldwell
- Sonya Chambers
- Philip Clay
All providers in Heathrow, FL · Physical Therapy Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2009. 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.