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Individual
DERRICK WAYNE RABURN
Active
Individual
DERRICK WAYNE RABURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT20241
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PT202413
PPIN - MEDICARE #
CA
Enumeration date
06/01/2006
Last updated
07/08/2007
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