Traci Annette Diveley, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A7261 Issued in NC

Practice address

10810 Sandy Oak LN
Raleigh, NC 27614-8386

Phone

(919) 846-7147

NPI assigned

Sep 14, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1326653676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 SUMMIT ARBOR DR APT 103",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123381",
            "telephone_number": "309-216-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10810 SANDY OAK LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148386",
            "telephone_number": "919-846-7147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVELEY",
        "first_name": "TRACI",
        "middle_name": "ANNETTE",
        "name_prefix": "Ms.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-14",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.001168",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "A7261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Ruth Ditesheim, LCSW-A
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• Divine Grace in-Home & Private Healthcare Service

• Physical Therapy Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physical Therapy Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.