Provider Demographics
NPI:1407462518
Name:STRAUS, DEREK ROBERT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:ROBERT
Last Name:STRAUS
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 1:8750 TALLON LN NE STE C
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6608
Mailing Address - Country:US
Mailing Address - Phone:360-456-1072
Mailing Address - Fax:360-459-9954
Practice Address - Street 1:8750 TALLON LN NE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6608
Practice Address - Country:US
Practice Address - Phone:360-456-1072
Practice Address - Fax:360-459-9954
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61099905208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation