Holly A Derouchey, PT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

8516 Issued in MN

Practice address

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4572

Phone

(763) 427-7300

Fax

(763) 427-2802

NPI assigned

Jul 20, 2010

Last updated

Jul 20, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  NPD (past)
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  • NPI 1144608589
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279584000000",
    "number": "1811200793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "SUITE 900",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728",
            "telephone_number": "952-512-5600",
            "fax_number": "952-512-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 124TH AVE NW",
            "address_2": "SUITE 200",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334572",
            "telephone_number": "763-427-7300",
            "fax_number": "763-427-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROUCHEY",
        "first_name": "HOLLY",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-20",
        "last_updated": "2010-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "8516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hope M Denn, MA
• Dental Specialists of Minnesota, PLLC (The Dental Specialists)
• Dental Specialists of Minnesota, PLLC (The Dental Specialists)
• Kailee A Derby
• Laura Michelle Derosier-Moran, MA
• Charles Vincent Derubeis, M.D.
• Akon K Dethl
• Adam Sean Devine, MD
• Crystal M Dexter, MD
• Nirvan K Dharampaul, DPT

• Physical Medicine & Rehabilitation Physician in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Physical Medicine & Rehabilitation Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.