Provider Demographics
NPI:1134338643
Name:HIGH, DERREKE VINCENT (PT)
Entity type:Individual
Prefix:
First Name:DERREKE
Middle Name:VINCENT
Last Name:HIGH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2035
Mailing Address - Street 2:
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-2035
Mailing Address - Country:US
Mailing Address - Phone:434-660-4475
Mailing Address - Fax:
Practice Address - Street 1:1051 VILLAGE HWY
Practice Address - Street 2:UNIT J
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588-3800
Practice Address - Country:US
Practice Address - Phone:180-059-1894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist