Provider Demographics
NPI:1003966672
Name:MILONE, DEREK (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:MILONE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:NORTH CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02650-0453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 ORLEANS RD
Practice Address - Street 2:
Practice Address - City:NORTH CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02650-1154
Practice Address - Country:US
Practice Address - Phone:508-945-9611
Practice Address - Fax:508-945-9603
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist