Active NPI
Ivette Derose, PHYSICAL THERAPIST
- Physical Therapist
- Scottsdale, AZ
National Provider Identifier
1891821096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1766
- Practice address
- 11607 E Caron St
Scottsdale, AZ 85259-5914 - Phone
- (602) 793-1006
- NPI assigned
- Feb 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 1766 | AZ | Primary |
Addresses
Primary practice location
11607 E Caron St
Scottsdale, AZ 85259-5914
Mailing address
11607 E Caron St
Scottsdale, AZ 85259-5914
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 |
|---|---|---|---|
| 1766 | AZ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891821096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11607 E CARON ST",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852595914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11607 E CARON ST",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852595914",
"telephone_number": "602-793-1006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROSE",
"first_name": "IVETTE",
"name_prefix": "Mrs.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "1766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scottsdale, AZ
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.