Provider Demographics
NPI:1215404421
Name:EAST, DEREK (PT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:EAST
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 RANCHESTER DR APT 50
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3757
Mailing Address - Country:US
Mailing Address - Phone:832-272-7937
Mailing Address - Fax:
Practice Address - Street 1:4710 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2800
Practice Address - Country:US
Practice Address - Phone:281-499-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist