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General NPI Number Information
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NPI Number | 1215676770
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Entity Type | Organization
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Legal Business Name | DIVERGENT REHAB AND WELLNESS LLC
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 1980 E 116TH ST STE 315
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City | CARMEL
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State | IN
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Zip | 46032-3517
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Country | US
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Telephone | 317-350-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 1980 E 116TH ST STE 315
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City | CARMEL
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State | IN
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Zip | 46032-3517
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Country | US
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Telephone | 317-350-4060
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | MICHAEL ALAN MURPHY
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Credential | PT, DPT
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Telephone | 651-239-3475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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