Derek Lewis Brockman, DPT
Individual provider Active NPI Physical Therapist · Scottsville, KY
NPI 1972116002 · NPPES record last updated Aug 28, 2020
Key facts
- NPI
- 1972116002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 007992 (KY)
- Practice address
- 102 W Maple St
Scottsville, KY 42164-1134 - Phone
- (270) 239-6640
- NPI assigned
- Aug 28, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007992 | KY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonwealth Health Corporation, Inc. | Past |
Accepting new patients | |
| Orthopedics Plus Physical Therapy | Past |
Accepting new patients | |
| Commonwealth Health Corporation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 007992 | KY | Yes |
Addresses
Primary practice location
102 W Maple St
Scottsville, KY 42164-1134
Mailing address
PO Box 2697
Bowling Green, KY 42102-7697
Other providers in Scottsville, KY
- Bowling Green-Warren County Community Hospital Corporation
- Bowling Green-Warren County Community Hospital Corporation
- Georgena Ann Brackett
- Adriana Bradshaw
- Breiwa, Ware & Jeskie PSC
- Lindsay Brown
- Lynne Brown
- Paul Bunn
- Amber A Busey
- Carpenter Dent Drugs Inc
All providers in Scottsville, KY · Physical Therapist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2020. 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.