Provider Demographics
NPI:1134223316
Name:TUOHY, DEREK C (MSPT, CSCS)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:C
Last Name:TUOHY
Suffix:
Gender:M
Credentials:MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2228
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-2228
Mailing Address - Country:US
Mailing Address - Phone:970-728-8948
Mailing Address - Fax:970-728-8953
Practice Address - Street 1:622 MOUNTAIN VILLAGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:81435-9505
Practice Address - Country:US
Practice Address - Phone:970-728-8948
Practice Address - Fax:970-728-8953
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8226208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC514088Medicare ID - Type Unspecified