Provider Demographics
NPI:1174747240
Name:DIVINCENZO, JOSEPH J (MSPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:DIVINCENZO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:DIVINCENZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JOSEPH
Mailing Address - Street 1:30 HOME ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4414
Mailing Address - Country:US
Mailing Address - Phone:617-359-1472
Mailing Address - Fax:
Practice Address - Street 1:77 HERRICK ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2734
Practice Address - Country:US
Practice Address - Phone:978-922-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist