Individual
DEREK R FLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4830 HIGHWAY 260 STE 105, LAKESIDE, AZ 85929-5851
(928) 532-1221
(928) 532-1227
Mailing address
PO BOX 1420, SHOW LOW, AZ 85902-1420
(928) 532-1221
(928) 532-1227
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8520PT
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8520PT
ARIZONA PT LICENSE
AZ
Enumeration date
12/01/2009
Last updated
03/16/2020
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