Individual
MR. BRUCE C DIVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2861 WEST RD., TRENTON, MI 48183-2400
(734) 675-2262
(734) 675-3430
Mailing address
506 COLE RD, MONROE, MI 48162-4111
(734) 241-7537
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5501002789
MI
225100000X
Physical Therapist
Primary
5501012324
MI
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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