Individual
DERICK DEANTE BOTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, ATC
Contact information
Practice address
464 SAINT LUKES DR, MONTGOMERY, AL 36117-7104
(334) 244-6699
Mailing address
464 SAINT LUKES DR, MONTGOMERY, AL 36117-7104
(334) 244-6699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1-1087
AL
225100000X
Physical Therapist
10118
AL
2255A2300X
Athletic Trainer
1839
AL
Other
Enumeration date
08/17/2020
Last updated
04/22/2026
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