Provider Demographics
NPI:1538290176
Name:DERINGTON, ROB ERT PARRIS (LAT)
Entity Type:Individual
Prefix:MR
First Name:ROB ERT
Middle Name:PARRIS
Last Name:DERINGTON
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WAGON WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2651
Mailing Address - Country:US
Mailing Address - Phone:210-649-1549
Mailing Address - Fax:
Practice Address - Street 1:1460 MARTINEZ LOSOYA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-9648
Practice Address - Country:US
Practice Address - Phone:210-882-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer