Provider Demographics
NPI:1184385338
Name:DIVINE MOVEMENT & CONSULTING LLC
Entity type:Organization
Organization Name:DIVINE MOVEMENT & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATRINA
Authorized Official - Middle Name:RISHEA
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:205-266-4199
Mailing Address - Street 1:125 LONG RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229
Mailing Address - Country:US
Mailing Address - Phone:205-266-4199
Mailing Address - Fax:
Practice Address - Street 1:125 LONG RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229
Practice Address - Country:US
Practice Address - Phone:205-266-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-09
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty