Provider Demographics
NPI:1225531247
Name:AITKEN, DEREK JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:JOHN
Last Name:AITKEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7111
Mailing Address - Country:US
Mailing Address - Phone:541-883-3327
Mailing Address - Fax:541-883-3175
Practice Address - Street 1:6420 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7111
Practice Address - Country:US
Practice Address - Phone:541-883-3327
Practice Address - Fax:541-883-3175
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist