Derek A Willis, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

036045 Issued in NY

Practice address

20 Trotting Dr
Chester, NY 10918-1120

Phone

(457) 425-1218

NPI assigned

Apr 1, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PT and OT for Senior Rehab at Home PLLCGroup PAC ID 2668711573, 97 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• PT and OT for Senior Rehab at Home PLLC

  • Geriatric Physical Therapist
  • Brooklyn, NY
  • NPI 1811463003
  Medicare reassignment Care Compare group NPD
• Sportscare Institute, Inc.

  • Physical Therapist
  • Toms River, NJ
  • NPI 1275501074
  NPD (past)

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1851634521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 GRAND ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100024464",
            "telephone_number": "464-768-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 TROTTING DR",
            "city": "CHESTER",
            "state": "NY",
            "postal_code": "109181120",
            "telephone_number": "457-425-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DEREK",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-01",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01490500",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "036045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neisha Wheeler
• Patricia Dymphna Whelan Wall, RN
• Madeline Victoria White, COTA/L
• William J. Harker LCSW, PC
• Stacey G. Williams, LCSW
• Kristine Lynne Wilson, LMHC.
• Tahitia Woods, RN
• Thomas Yuen, MD

• Physical Therapist in Chester, NY
• Providers in Chester, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.