Provider Demographics
NPI:1881639540
Name:HOPE, DERECK B (PT)
Entity Type:Individual
Prefix:MR
First Name:DERECK
Middle Name:B
Last Name:HOPE
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 1:1551 RENAISSANCE TOWNE DR STE 350
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7674
Mailing Address - Country:US
Mailing Address - Phone:801-295-3553
Mailing Address - Fax:801-295-3599
Practice Address - Street 1:1266 LEGEND HILLS DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-2274
Practice Address - Country:US
Practice Address - Phone:801-776-6000
Practice Address - Fax:801-776-1166
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124557Medicaid