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Individual

DEREK P PRICE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
303 N WILLIAM KUMPF BLVD, PEORIA, IL 61605-2507
(309) 676-5546
Mailing address
303 N. WILLLIAM KUMPF BLVD, PEORIA, IL 61605-2507
(309) 676-5546

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070009305
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CH8612
RR MEDICARE
IL
Enumeration date
05/20/2006
Last updated
04/15/2010
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