Provider Demographics
NPI:1629039136
Name:KLING, DEREK A (DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:A
Last Name:KLING
Suffix:
Gender:M
Credentials:DPT
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Mailing Address - Street 1:20 PARK PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9806
Mailing Address - Country:US
Mailing Address - Phone:717-477-8030
Mailing Address - Fax:717-477-8040
Practice Address - Street 1:118 WALNUT ST
Practice Address - Street 2:UNIT 114
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-1669
Practice Address - Country:US
Practice Address - Phone:717-655-5681
Practice Address - Fax:717-655-5691
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2015-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPT019071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024483110003Medicaid
PA174704V9XMedicare PIN