Provider Demographics
NPI:1366585945
Name:DEERING THERAPY SERVICES LTD
Entity type:Organization
Organization Name:DEERING THERAPY SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEERING
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:928-753-4263
Mailing Address - Street 1:PO BOX 3278
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409
Mailing Address - Country:US
Mailing Address - Phone:928-753-4263
Mailing Address - Fax:928-753-1173
Practice Address - Street 1:1841 MORROW AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409
Practice Address - Country:US
Practice Address - Phone:928-753-4263
Practice Address - Fax:928-753-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0104225X00000X
AZ1689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ908329Medicaid
Z28447Medicare PIN
AZ908329Medicaid
AZZ28449Medicare PIN
AZZ28448Medicare PIN