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NPI Code Detail

MEDICARE: DIVERGENT REHAB AND WELLNESS LLC

MEDICARE: DIVERGENT REHAB AND WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1215676770
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVERGENT REHAB AND WELLNESS LLC
Provider Business Mailing Address
First Line : 1980 E 116TH ST STE 315
Second Line :
City : CARMEL
State : IN
Zip : 46032-3517
Country : US
Telephone Number : 317-350-4060
Fax Number :
Provider Business Practice Location Address
First Line : 1980 E 116TH ST STE 315
Second Line :
City : CARMEL
State : IN
Zip : 46032-3517
Country : US
Telephone Number : 317-350-4060
Fax Number :
Authorized Official
Title or Position : DOCTOR OF PHYSICAL THERAPY
Name : MICHAEL ALAN MURPHY
Credential : PT, DPT
Telephone Number : 651-239-3475
Provider Enumeration Date : 06/02/2022
Last Update Date : 06/02/2022

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Directions to “DIVERGENT REHAB AND WELLNESS LLC ” Practice Location

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