Mary Beth Polvoorde-Divis, MS, MPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT008160L Issued in PA

Practice address

719 S Chester Rd
Swarthmore, PA 19081-2710

Phone

(610) 543-4605

NPI assigned

Jul 12, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optimum Physical Therapy Associates, P.C.

  • Physical Therapist
  • Swarthmore, PA
  • NPI 1467521427
  NPD (past)

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

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342051200000",
    "number": "1659636827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LOCUST LN",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190631733",
            "telephone_number": "610-891-0975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 S CHESTER RD",
            "city": "SWARTHMORE",
            "state": "PA",
            "postal_code": "190812710",
            "telephone_number": "610-543-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLVOORDE-DIVIS",
        "first_name": "MARY BETH",
        "name_prefix": "Mrs.",
        "credential": "MS, MPT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-12",
        "last_updated": "2012-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT008160L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Path to Movement Health & Wellness LLC
• Ryan Peeters, DPT
• Pennsylvania CVS Pharmacy, L.L.C.
• Emma Phibbs, DPT
• Pinwheels Early Childhood Therapy Center
• Gwenn Prinbeck
• Susan Proulx, PSY.D.
• Gene Robert Purdie Jr., MA, LPC
• Amy Purrington, MD
• Renee Rankine

• Physical Therapist in Swarthmore, PA
• Providers in Swarthmore, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.