| NPI Details | |
|---|---|
| NPI | 1104154269 |
| Gender | Male |
| Enumeration Date | 12/01/2009 |
| Last Updated | 05/16/2014 |
| Entity Type | Individual |
| Active | Over 8 years ago |
| Practice Location | |
|---|---|
| 2940 E BANNER GATEWAY DR STE 200 GILBERT AZ, 85234-2171, US |
|
| Phone | (480) 964-2908 |
| Fax | (480) 833-2136 |
| Business Location | |
|---|---|
| PO BOX 29870 PHOENIX AZ, 85038-9870, US |
|
| Phone | (602) 772-3800 |
| Fax | (602) 772-3801 |
| Toxanomy | |
|---|---|
| Taxonomy Code | 225100000X |
| License State | Arizona |
| License Number | 8520PT |
| Remove 1104154269 NPI Number | |
According to our database, Derek R Flake PT NPI is 1104154269, taxonomy code is 225100000X and license number is 8520PT, license state is located at Arizona. Derek R Flake PT physically located at 2940 E Banner Gateway Dr, Gilbert AZ, 85234-2171. NPI Number Derek R Flake PT has the Individual type.
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1104154269 NPI number is provided on an as is basis without warranty of any kind. 1104154269 is maintained by the National Plan & Provider Enumeration System. The contents of Derek R Flake PT are for informational purposes only.
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