Individual
DEREK PEQUETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1275 N CONVENT ST, SUITE 3, BOURBONNAIS, IL 60914-8210
(815) 936-1855
(815) 936-6097
Mailing address
900 RAND RD STE 300, DES PLAINES, IL 60016-2359
(847) 324-3976
(847) 929-1154
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05006860A
IN
225100000X
Physical Therapist
Primary
070012002
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00886041
RR MEDICARE
IL
Enumeration date
09/21/2006
Last updated
04/22/2025
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