Provider Demographics
NPI:1871309393
Name:WASHINGTON, DEREK CHRISTOPHER (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:CHRISTOPHER
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 CARLOW
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-1941
Mailing Address - Country:US
Mailing Address - Phone:210-763-2110
Mailing Address - Fax:
Practice Address - Street 1:417 CARLOW
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-1941
Practice Address - Country:US
Practice Address - Phone:210-763-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1402851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist