Provider Demographics
NPI:1376129221
Name:NISHIKAWA, DEREK KENSAKU (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:KENSAKU
Last Name:NISHIKAWA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 FRANCES AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1969
Mailing Address - Country:US
Mailing Address - Phone:818-237-7390
Mailing Address - Fax:
Practice Address - Street 1:3027 FRANCES AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1969
Practice Address - Country:US
Practice Address - Phone:818-237-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist