Individual
THERESA DIVITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9862 OLD RIDGE RD, SPRING VALLEY, CA 91977-3462
(619) 436-7374
Mailing address
9862 OLD RIDGE RD, SPRING VALLEY, CA 91977-3462
(619) 436-7374
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 4267
CA
Other
Enumeration date
12/02/2016
Last updated
12/02/2016
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