Individual
MR. DERICK PAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1330 PRAIRIE AVE, CHEYENNE, WY 82009-4842
(307) 778-8997
Mailing address
8132 OLD TAVERN RD, ROANOKE, VA 24019-6807
(540) 793-2415
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306001374
VA
Other
Enumeration date
06/01/2007
Last updated
07/08/2007
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