Individual
MR. DEREK NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1109 W CLAIREMONT AVE, EAU CLAIRE, WI 54701-6105
(715) 717-5367
Mailing address
24405 COUNTY HIGHWAY F, NEW AUBURN, WI 54757-5346
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2176-19
WI
Other
Enumeration date
02/22/2018
Last updated
12/29/2021
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