Individual
RYAN DIVITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
TEACHER
Contact information
Practice address
26 SAN FERNANDO LN, EAST AMHERST, NY 14051-2234
(716) 472-1289
(716) 689-2916
Mailing address
153 BRAMBLE CT, WILLIAMSVILLE, NY 14221-1715
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
—
NY
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
Primary
—
—
Other
Enumeration date
06/08/2022
Last updated
06/08/2022
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