Individual
LAURA R DERRICOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
104 MACDUFF RD, NEWARK, DE 19711-1514
(585) 613-5257
Mailing address
104 MACDUFF RD, NEWARK, DE 19711-1514
(585) 613-5257
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
23799
MD
225100000X
Physical Therapist
Primary
J1-0004020
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01059773
MEDICARE RAILROAD
MD
Enumeration date
01/24/2012
Last updated
01/29/2021
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