# DEVINE PHYSICAL THERAPY, ACUPUNCTURE AND MASSAGE THERAPY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952830960
- **Authorized official:** JENNIFER OLSEN P.T., D.P.T. (MANAGER)
- **Authorized official phone:** (631) 320-1100

## Contact information

- **Practice address:** 10 FORT SALONGA RD STE 2A, FORT SALONGA, NY 11768-1400
- **Practice address phone:** (631) 320-1100
- **Practice address fax:** (631) 343-7174
- **Mailing address:** PMB 373, 186 SEVEN FARMS DRIVE, STE F, DANIEL ISLAND, SC 29492
- **Mailing address phone:** (516) 662-9962
- **Mailing address fax:** (631) 343-7174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/05/2017
- **Last updated:** 05/03/2019