Provider Demographics
NPI:1669012852
Name:BELAN, DERRICK JAVIER (DPT)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:JAVIER
Last Name:BELAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19251 PRESTON RD APT 2806
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-8542
Mailing Address - Country:US
Mailing Address - Phone:409-679-6639
Mailing Address - Fax:
Practice Address - Street 1:14665 MIDWAY RD STE 110
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3185
Practice Address - Country:US
Practice Address - Phone:972-382-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1326256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist