Provider Demographics
NPI:1912512039
Name:SEKUTERSKI, DERRICK MATTHEW (PT)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:MATTHEW
Last Name:SEKUTERSKI
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 1:5102 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4465
Mailing Address - Country:US
Mailing Address - Phone:716-683-9315
Mailing Address - Fax:716-683-7961
Practice Address - Street 1:5102 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4465
Practice Address - Country:US
Practice Address - Phone:716-683-9315
Practice Address - Fax:716-683-7961
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist