Provider Demographics
NPI:1467798421
Name:DIVINE THERAPY & WELLNESS LLC.
Entity Type:Organization
Organization Name:DIVINE THERAPY & WELLNESS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:865-776-4700
Mailing Address - Street 1:3300 SW 34TH AVE
Mailing Address - Street 2:SUITE 124 B
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7448
Mailing Address - Country:US
Mailing Address - Phone:352-562-7772
Mailing Address - Fax:321-400-1422
Practice Address - Street 1:3300 SW 34TH AVE
Practice Address - Street 2:SUITE 124 B
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7448
Practice Address - Country:US
Practice Address - Phone:352-562-7772
Practice Address - Fax:321-400-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27022261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy