Provider Demographics
NPI:1245718469
Name:DIVINE CSRD, LLC
Entity type:Organization
Organization Name:DIVINE CSRD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHARGAV
Authorized Official - Middle Name:ARVINDKUMAR
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:248-416-3321
Mailing Address - Street 1:2804 FIELD HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1848
Mailing Address - Country:US
Mailing Address - Phone:248-416-3321
Mailing Address - Fax:888-789-2329
Practice Address - Street 1:608 FARM TO MARKET ROAD 517 WEST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539
Practice Address - Country:US
Practice Address - Phone:832-932-7900
Practice Address - Fax:832-932-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty