Provider Demographics
NPI:1851886816
Name:TALLEY, DERRICK (DPT)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:TALLEY
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 1:14287 N 87TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3698
Mailing Address - Country:US
Mailing Address - Phone:602-329-8250
Mailing Address - Fax:
Practice Address - Street 1:1626 N LITCHFIELD RD STE 310
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1397
Practice Address - Country:US
Practice Address - Phone:623-935-0734
Practice Address - Fax:623-935-0934
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist