MEDICARE: DIVYA SEHGAL MPT

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
1	2251P0200X	Pediatric Physical Therapist	031337-1	NY

General Provider Information

NPI Number	:	1518204189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIVYA SEHGAL MPT

Provider Business Mailing Address
First Line	:	10460 QUEENS BLVD APT 9U
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7347
Country	:	US
Telephone Number	:	617-475-5064
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 FOSTER AVE STE B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2130
Country	:	US
Telephone Number	:	718-853-1750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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