Individual
DERRICK NORTHRUP
Active
Individual
DERRICK NORTHRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
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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