Provider Demographics
NPI:1316082126
Name:NARAYANAN, DIVYA (MDT, PT)
Entity type:Individual
Prefix:MRS
First Name:DIVYA
Middle Name:
Last Name:NARAYANAN
Suffix:
Gender:F
Credentials:MDT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11780 OLIO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7617
Mailing Address - Country:US
Mailing Address - Phone:317-577-1744
Mailing Address - Fax:317-577-1760
Practice Address - Street 1:11780 OLIO RD STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7617
Practice Address - Country:US
Practice Address - Phone:317-577-1744
Practice Address - Fax:317-577-1760
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007690A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
234960AMedicare PIN