Provider Demographics
NPI:1861260432
Name:CONDUFF, DEREK ALLEN
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:ALLEN
Last Name:CONDUFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLONA
Mailing Address - State:IL
Mailing Address - Zip Code:61241-9622
Mailing Address - Country:US
Mailing Address - Phone:309-684-1253
Mailing Address - Fax:
Practice Address - Street 1:985 AVENUE OF THE CITIES STE 105
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-7001
Practice Address - Country:US
Practice Address - Phone:309-762-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist