Individual
MRS. JENNIFER LEE DERHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
7728 204TH ST. NE, #A, ARLINGTON, WA 98223
(360) 403-8250
(360) 403-0917
Mailing address
11453 E REUBEN AVE, MESA, AZ 85212-4113
(425) 750-9526
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
7452
AZ
225100000X
Physical Therapist
Primary
PT00010288
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
226582
L&I
WA
01
—
3317BE
REGENCE B/S
WA
01
—
6417BE
REGENCE
WA
01
—
8156BE
REGENCE
WA
01
—
8498560
DSHS
WA
01
—
8841BE
REGENCE
WA
01
—
8869473
MEDICARE
WA
01
—
8946137
L&I CRIME
WA
01
—
9788127
AETNA
WA
01
—
P00608949
RAILROAD MEDICARE
WA
Enumeration date
01/30/2007
Last updated
11/14/2023
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