Provider Demographics
NPI:1467717017
Name:STOKES, DEREK R (PT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:R
Last Name:STOKES
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 1:706 BROWNING AVE S
Mailing Address - Street 2:APT 7
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6177
Mailing Address - Country:US
Mailing Address - Phone:503-290-4081
Mailing Address - Fax:
Practice Address - Street 1:233 MADRONA AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4609
Practice Address - Country:US
Practice Address - Phone:503-566-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist