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General NPI Number Information
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NPI Number | 1205324258
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Entity Type | Individual
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Provider Name | DIVYA SHAH WAGHRAY PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 275 STEELE RD
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2716
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Country | US
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Telephone | 860-570-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 275 STEELE RD
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2716
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Country | US
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Telephone | 860-570-8200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05015176A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305215630
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501006522
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14.013933
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0018036
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License Number State | CO
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