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General NPI Number Information
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NPI Number | 1679657829
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Entity Type | Individual
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Provider Name | BRUCE C DIVEN PT
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2861 WEST RD.
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City | TRENTON
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State | MI
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Zip | 48183-2400
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Country | US
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Telephone | 734-675-2262
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Fax | 734-675-3430
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Provider Business Mailing Address
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Address Line | 506 COLE RD
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City | MONROE
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State | MI
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Zip | 48162-4111
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Country | US
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Telephone | 734-241-7537
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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 | 5501002789
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License Number State | MI
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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 | 5501012324
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License Number State | MI
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