Diversa Care Therapeutics, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501005682 Issued in MI

Legal business name

DIVERSA CARE THERAPEUTICS, INC

Practice address

12 Kingsley CT
Frankenmuth, MI 48734-1270

Phone

(989) 992-1671

NPI assigned

Mar 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Daniel Patrick Peterson, P.T.

Title

Owner

Phone

(989) 992-1671

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350604800000",
    "number": "1003931114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 KINGSLEY CT",
            "city": "FRANKENMUTH",
            "state": "MI",
            "postal_code": "487341270",
            "telephone_number": "989-992-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 KINGSLEY CT",
            "city": "FRANKENMUTH",
            "state": "MI",
            "postal_code": "487341270",
            "telephone_number": "989-992-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSA CARE THERAPEUTICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2012-10-19",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-992-1671",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501005682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Frankenmuth, MI
• Providers in Frankenmuth, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.