Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Derek Widener, PTA

Individual provider Physical Therapy Assistant · NPI 1154691624

Derek Widener, PTA is a Physical Therapy Assistant in Santa Rosa, California. Licensed in California. Registered with an NPI since 2011.

Licensed in
CA
In the registry since
2011
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

1221 N Dutton Ave
Santa Rosa, CA 95401-4607
Phone: (707) 543-8360
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 6568 (CA)

Record details

NPI number1154691624
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedDecember 30, 2011
Last updated in NPPESDecember 30, 2011

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