Provider Demographics
NPI:1861699639
Name:DERRICK, BRET SHERIDAN (PT, DPT, OCS)
Entity type:Individual
Prefix:MR
First Name:BRET
Middle Name:SHERIDAN
Last Name:DERRICK
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:111 E BROADWAY STE 340
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4208
Mailing Address - Country:US
Mailing Address - Phone:573-808-2392
Mailing Address - Fax:888-738-3034
Practice Address - Street 1:111 E BROADWAY STE 340
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4208
Practice Address - Country:US
Practice Address - Phone:573-808-2392
Practice Address - Fax:888-738-3034
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO012482251E1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics