Provider Demographics
NPI:1336235217
Name:CRAMPTON, DERRICK CARL (PT)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:CARL
Last Name:CRAMPTON
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 1:931 HIGHWAY 331 UNIT H
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435
Mailing Address - Country:US
Mailing Address - Phone:850-892-7644
Mailing Address - Fax:850-892-0420
Practice Address - Street 1:931 HIGHWAY 331 UNIT H
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435
Practice Address - Country:US
Practice Address - Phone:850-892-7644
Practice Address - Fax:850-892-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2458225100000X
FL38368208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
243700402OtherMEDICARE LEGACY
100835470AOtherMEDICAID LEGACY
OK100835470AMedicaid
7347031OtherAETNA