Provider Demographics
NPI:1295976785
Name:HAMLEY, DERIK CHARLES (MPT)
Entity type:Individual
Prefix:MR
First Name:DERIK
Middle Name:CHARLES
Last Name:HAMLEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 VINSON WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-4240
Mailing Address - Country:US
Mailing Address - Phone:941-342-3411
Mailing Address - Fax:
Practice Address - Street 1:777 S PALM AVE
Practice Address - Street 2:SUIT 10
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7770
Practice Address - Country:US
Practice Address - Phone:941-330-1677
Practice Address - Fax:941-330-1688
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist