Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA00930000 | NJ |
NPI | 1003137415 |
---|---|
Provider Name | Regina A Derikito |
First Address | Cherry Hill, NJ 08003-1020 |
Second Address | Cherry Hill, NJ 08003-1020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 08/03/2013 |