Provider Demographics
NPI:1952774820
Name:GOKEE, DEREK DOUGLAS (DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:DOUGLAS
Last Name:GOKEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 E DONALD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46613-3524
Mailing Address - Country:US
Mailing Address - Phone:616-755-0968
Mailing Address - Fax:
Practice Address - Street 1:1514 E DONALD ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-3524
Practice Address - Country:US
Practice Address - Phone:616-755-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist