Provider Demographics
NPI:1053326520
Name:DEREU, DARRIN W (ATC)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:W
Last Name:DEREU
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 SOSA RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4097
Mailing Address - Country:US
Mailing Address - Phone:919-513-7295
Mailing Address - Fax:
Practice Address - Street 1:N CAROLINA STATE UNIVERSITY
Practice Address - Street 2:2500 WARREN CARROL DRIVE, BOX 8502
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-8502
Practice Address - Country:US
Practice Address - Phone:919-513-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer