Healthcare Provider Details

I. General information

NPI: 1285564674
Provider Name (Legal Business Name): DIVINE PHYSICAL THERAPY & PELVIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 HARD BARGAIN CIR
INDIAN HEAD MD
20640-3041
US

IV. Provider business mailing address

6260 HARD BARGAIN CIR
INDIAN HEAD MD
20640-3041
US

V. Phone/Fax

Practice location:
  • Phone: 832-679-1780
  • Fax:
Mailing address:
  • Phone: 832-679-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HEENA KALATHIYA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT,MS
Phone: 832-679-1780