Provider Demographics
NPI:1205324258
Name:WAGHRAY, DIVYA SHAH (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:DIVYA
Middle Name:SHAH
Last Name:WAGHRAY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 STEELE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2716
Mailing Address - Country:US
Mailing Address - Phone:860-570-8200
Mailing Address - Fax:
Practice Address - Street 1:275 STEELE RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2716
Practice Address - Country:US
Practice Address - Phone:860-570-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015176A225100000X
VA2305215630225100000X
MI5501006522225100000X
CT14.013933225100000X
CO0018036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist