Provider Demographics
NPI:1013735182
Name:BASKIN, DERRICK HALE (DPT)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:HALE
Last Name:BASKIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 ARENA CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6327
Mailing Address - Country:US
Mailing Address - Phone:757-403-6711
Mailing Address - Fax:
Practice Address - Street 1:1001 SCENIC PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-6720
Practice Address - Country:US
Practice Address - Phone:757-388-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist