Provider Demographics
NPI:1023413291
Name:ROCKWELL, DEREK (PT,DPT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 N RUSHWOOD ST APT 1202
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2500
Mailing Address - Country:US
Mailing Address - Phone:620-960-2304
Mailing Address - Fax:
Practice Address - Street 1:700 MONTEREY PL
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2266
Practice Address - Country:US
Practice Address - Phone:620-663-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist