MEDICARE: DIVINE THERAPY AND WELLNESS AR,PLLC

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1689365959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE THERAPY AND WELLNESS AR,PLLC

Provider Business Mailing Address
First Line	:	794 ARBUCKLE AVE
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-2706
Country	:	US
Telephone Number	:	718-249-6048
Fax Number	:	718-228-2644

Provider Business Practice Location Address
First Line	:	1422 FRESNO ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-7065
Country	:	US
Telephone Number	:	718-249-6048
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALAN BERKOVITCH
Credential	:	DPT
Telephone Number	:	718-249-6048

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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