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General NPI Number Information
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NPI Number | 1518758713
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Entity Type | Organization
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Legal Business Name | DIVERGENT PHYSICAL THERAPY & WELLNESS, LLC
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 1322 ANDREA ST
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City | YPSILANTI
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State | MI
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Zip | 48198-6605
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Country | US
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Telephone | 734-325-4404
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Fax | 734-888-9141
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Provider Business Mailing Address
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Address Line | 1322 ANDREA ST
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City | YPSILANTI
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State | MI
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Zip | 48198-6605
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Country | US
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Telephone | 734-325-4404
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Fax | 734-888-9141
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Authorized Official
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Title or Position | OWNER
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Name | GINGERANN NESLUND
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Credential | DPT
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Telephone | 734-325-4404
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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 |
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License Number State |
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