Individual
DR. DERRICK BLAINE HINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1144 COOLIDGE BLVD, SUITE F, LAFAYETTE, LA 70503-2622
(337) 232-8721
Mailing address
139 ASHLAND CT, LAFAYETTE, LA 70508-5373
(337) 232-8721
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
08100
LA
225100000X
Physical Therapist
PTH6216
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I656395
MEDICARE PTAN
LA
Enumeration date
08/01/2011
Last updated
02/26/2014
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