Individual
JACQUE D DERR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT, LOTR
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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