Basic Information
| Provider Information | |||||||||
| NPI: | 1346887445 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIVINE PHYSICAL THERAPY & WELLNESS CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11575 PEARLAND PKWY APT 3301 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770892647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4084443080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11575 PEARLAND PKWY APT 3301 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770892647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4084443080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2019 | ||||||||
| LastUpdateDate: | 12/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | VAIDYA | ||||||||
| AuthorizedOfficialFirstName: | AADITYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4084443080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/08/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.