Provider Demographics
NPI:1689365959
Name:DIVINE THERAPY AND WELLNESS AR,PLLC
Entity Type:Organization
Organization Name:DIVINE THERAPY AND WELLNESS AR,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-249-6048
Mailing Address - Street 1:794 ARBUCKLE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2706
Mailing Address - Country:US
Mailing Address - Phone:718-249-6048
Mailing Address - Fax:718-228-2644
Practice Address - Street 1:1422 FRESNO ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7065
Practice Address - Country:US
Practice Address - Phone:718-249-6048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty