Healthcare Provider Details

I. General information

NPI: 1861866766
Provider Name (Legal Business Name): PIRANI HOLDING COMPANY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 1602
JACKSONVILLE FL
32216-6298
US

IV. Provider business mailing address

6817 SOUTHPOINT PKWY STE 1602
JACKSONVILLE FL
32216-6298
US

V. Phone/Fax

Practice location:
  • Phone: 904-945-7556
  • Fax: 904-379-0113
Mailing address:
  • Phone: 904-945-7556
  • Fax: 904-379-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number12058
License Number StateFL

VIII. Authorized Official

Name: DR. DIVYA MAJMUDAR PIRANI
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT, PCS
Phone: 919-247-2450