Provider Demographics
NPI:1073182002
Name:ABRAHAM, DIVYA (DPT)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 PASEO VERDE PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6616
Mailing Address - Country:US
Mailing Address - Phone:702-312-4878
Mailing Address - Fax:702-312-4886
Practice Address - Street 1:2651 PASEO VERDE PKWY STE 170
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6616
Practice Address - Country:US
Practice Address - Phone:702-312-4878
Practice Address - Fax:702-312-4886
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1294650225100000X
NV5194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist