Provider Demographics
NPI:1811284581
Name:RICH, DIVINA (PT)
Entity type:Individual
Prefix:
First Name:DIVINA
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 ANDREWS WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2784
Mailing Address - Country:US
Mailing Address - Phone:808-346-2473
Mailing Address - Fax:
Practice Address - Street 1:1500 PALM BEACH RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4044
Practice Address - Country:US
Practice Address - Phone:772-283-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL264762251G0304X
CO44802251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics