Individual
DEREK JASON CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2400 13TH STREET, ASHLAND, KY 41102
(606) 329-0910
(606) 325-9848
Mailing address
PO BOX 1240, ASHLAND, KY 41105
(606) 325-7955
(606) 325-9848
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA02738
OH
225200000X
Physical Therapy Assistant
Primary
PTAA000952
KY
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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