Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | J10001606 | DE |
N | 2251E1200X | Ergonomics | J10001606 | DE |
N | 225XE1200X | Ergonomics | J10001606 | DE |
N | 2251G0304X | Physical Therapist - Geriatrics | J10001606 | DE |
N | 2251S0007X | Physical Therapist - Sports | J10001606 | DE |
Y | 2251X0800X | Physical Therapist - Orthopedic | J10001606 | DE |
NPI | 1043273717 |
---|---|
Provider Name | Jennifer Ferguson Divita |
First Address | Dover, DE 19901-4968 |
Second Address | Dover, DE 19901-4968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
146729900 | DEPART OF LABOR (01) | DE |
2623565000 | AMERIHEALTH (01) | DE |
P90053 | (02) | DE |