Provider Demographics
NPI:1235141839
Name:LEVY, DERICK (PT)
Entity Type:Individual
Prefix:MR
First Name:DERICK
Middle Name:
Last Name:LEVY
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 1:3865 CHERRY CREEK NORTH DR
Mailing Address - Street 2:LL70
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3803
Mailing Address - Country:US
Mailing Address - Phone:303-394-3356
Mailing Address - Fax:303-394-3359
Practice Address - Street 1:3865 CHERRY CREEK NORTH DR
Practice Address - Street 2:LL70
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3803
Practice Address - Country:US
Practice Address - Phone:303-394-3356
Practice Address - Fax:303-394-3359
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO478038Medicare PIN