Individual
DERRICK NORTHRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
605 TAYLOR LN, CHUBBUCK, ID 83202-5169
(208) 221-6952
(844) 946-0909
Mailing address
605 TAYLOR LN, CHUBBUCK, ID 83202-5169
(208) 221-6952
(844) 946-0909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1280
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805245100
—
ID
01
—
T6939
BLUE CROSS OF IDAHO
ID
Enumeration date
12/04/2006
Last updated
03/20/2020
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