| Doctor Name: | DEREK MARIO DECICCO |
| NPI Number: | 1427283894 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPT |
| License Number: | 33639 |
| Business Practice Address: | 15775 Laguna Canyon Rd Ste 110 Irvine, CA - 926183192 |
| Business Phone Number: | 7148584617 |
| Business Fax Number: | |
| Mailing Address: | 1154 Mission Dr, COSTA MESA |
| State: | CA |
| Postal Code: | 926264209 |
| Phone Number: | 7143820673 |
| Fax Number: | |
| NPI Enumeration Date: | 05/28/2009 |
| NPI Last Update Date: | 02/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 33639 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |