MEDICARE: DIVYA NATESAN PT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1124606488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVYA NATESAN PT LLC

Provider Business Mailing Address
First Line	:	390 MASSACHUSETTS AVE STE 1
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-6799
Country	:	US
Telephone Number	:	617-595-8193
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 MASSACHUSETTS AVE STE 1
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-6799
Country	:	US
Telephone Number	:	617-595-8193
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DIVYA NATESAN
Credential	:	PT, DPT
Telephone Number	:	617-595-8193

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	03/30/2021

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