Individual
BRANDON WAYNE DIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, PT
Contact information
Practice address
17134 BEL RAY PL, BELTON, MO 64012-5331
(816) 318-0434
(816) 318-0437
Mailing address
535 E NORTH ST STE C, BRADLEY, IL 60915-1188
(815) 802-7503
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070.024617
IL
225100000X
Physical Therapist
Primary
2022039968
MO
Other
Enumeration date
08/22/2019
Last updated
10/06/2022
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