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1124196340
DERRICK NORTHRUP
CHUBBUCK, ID
NPI
1124196340
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: ID PT1280)
Enumeration Date
2006-12-04
Last Update Date
2020-03-20
Business Address
DERRICK NORTHRUP P.T.
605 TAYLOR LN
CHUBBUCK, ID 83202-5169
Phone number: 208-221-6952
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Mailing Address
DERRICK NORTHRUP P.T.
605 TAYLOR LN
CHUBBUCK, ID 83202-5169
Phone number: 208-221-6952
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