Individual
DIVINO AVELLANOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 BRIARCLIFF RD, BRANSON, MO 65616-3735
(417) 339-4069
Mailing address
109 BRIARCLIFF RD, BRANSON, MO 65616-3735
(417) 339-4069
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1650
AR
2251G0304X
Geriatric Physical Therapist
—
—
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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