Provider Demographics
NPI:1154529931
Name:DIVEN, JEAN M
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:M
Last Name:DIVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 1315B
Mailing Address - Street 2:
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059
Mailing Address - Country:US
Mailing Address - Phone:717-436-9869
Mailing Address - Fax:
Practice Address - Street 1:102 CHANDRA DR
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-9745
Practice Address - Country:US
Practice Address - Phone:717-834-4111
Practice Address - Fax:717-834-6332
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000015L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant