Provider Demographics
NPI:1326238718
Name:DAVIDSON, DEREK C (DO, MSPT)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:C
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DO, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PINECREST AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4541
Mailing Address - Country:US
Mailing Address - Phone:978-502-7931
Mailing Address - Fax:
Practice Address - Street 1:271 PARK ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3311
Practice Address - Country:US
Practice Address - Phone:413-785-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272213208100000X
TXBP10050540208100000X
MA17700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist