Deiderich A Dutchover, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2130099 Issued in TX

Practice address

7710 W Interstate 10
San Antonio, TX 78230-4711

Phone

(210) 377-3355

NPI assigned

Aug 23, 2018

Last updated

May 29, 2020By the provider in NPPES

Sex

Male

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590710400000",
    "number": "1912488495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7710 W INTERSTATE 10",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782304711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7710 W INTERSTATE 10",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782304711",
            "telephone_number": "210-377-3355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "202 Billie Dr",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "TX",
            "postal_code": "786245056",
            "country_code": "US",
            "telephone_number": "830-997-8840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUTCHOVER",
        "first_name": "DEIDERICH",
        "middle_name": "A",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-23",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2130099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Furkan Dursun, MD
• Onyinyechi Crystal Duru
• Lindsay Elise Dusek, M.A.
• Sara Dusougi Mohamed, PA
• Monica M Dussan, MD
• Patricia Anne Duterroil, LPC NCC
• Gregory Paul Dutson, D.C.
• Anukampa Dutt, DDS, MS
• Anil Kumar Dutta, M.D.
• Oshmi Dutta, BDS, DDS, MS

• Physical Therapy Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; 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.