Individual
JACQUE D DERR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT, LOTR
Contact information
Practice address
915 1ST ST, WINNFIELD, LA 71483-2945
(318) 648-0212
(318) 648-3536
Mailing address
PO BOX 856, OLLA, LA 71465-0856
(318) 495-3312
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06898
LA
225X00000X
Occupational Therapist
OTT.Z12112
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
MEDICARE PENDING APPLICATION
—
Enumeration date
04/15/2010
Last updated
04/15/2010
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