Provider Demographics
NPI:1235963240
Name:STRATE, DEREK RONALD (DPT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:RONALD
Last Name:STRATE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2413 EAGLE DR APT 201
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-5743
Mailing Address - Country:US
Mailing Address - Phone:801-919-6936
Mailing Address - Fax:
Practice Address - Street 1:1510 ELK CREEK DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8322
Practice Address - Country:US
Practice Address - Phone:208-522-7627
Practice Address - Fax:208-524-6300
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID4261873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist