Individual
DEREK FAIRROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1500 PRIDE AVE, MADISONVILLE, KY 42431-9157
(270) 821-1813
Mailing address
1500 PRIDE AVE, MADISONVILLE, KY 42431-9157
(270) 821-1813
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A02649
KY
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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