Provider Demographics
NPI:1740617554
Name:SPEAKER, DEREK RYAN (PT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:RYAN
Last Name:SPEAKER
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 1:1781 WILLOW WIND DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1239
Mailing Address - Country:US
Mailing Address - Phone:419-307-8150
Mailing Address - Fax:
Practice Address - Street 1:1781 WILLOW WIND DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1239
Practice Address - Country:US
Practice Address - Phone:419-307-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist