Individual
DEREK VANDERROEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3117 STILLWATER DR, PRESCOTT, AZ 86305-7164
(928) 442-0005
Mailing address
3117 STILLWATER DR, PRESCOTT, AZ 86305-7164
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9028A
AZ
Other
Enumeration date
09/08/2010
Last updated
09/08/2010
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