Provider Demographics
NPI:1679505994
Name:LUND, DEREK MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:MICHAEL
Last Name:LUND
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 1:6704 STERLING RIDGE DR
Mailing Address - Street 2:STE E
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2799
Mailing Address - Country:US
Mailing Address - Phone:281-419-3100
Mailing Address - Fax:281-419-3101
Practice Address - Street 1:6704 STERLING RIDGE DR
Practice Address - Street 2:STE E
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2799
Practice Address - Country:US
Practice Address - Phone:281-419-3100
Practice Address - Fax:281-419-3101
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106276208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ28976Medicare UPIN
TX8C8638Medicare ID - Type Unspecified