Basic Information
| Provider Information | |||||||||
| NPI: | 1821305970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIVINE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1119 | ||||||||
| Address2: | |||||||||
| City: | STEPHENS CITY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226551119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408689599 | ||||||||
| FaxNumber: | 5408689699 | ||||||||
| Practice Location | |||||||||
| Address1: | 2811 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245404117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347996100 | ||||||||
| FaxNumber: | 4347991116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2010 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305206638 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.