Provider Demographics
NPI:1306893185
Name:PADILLA, DIVINE GRACE MEER (PT)
Entity type:Individual
Prefix:MRS
First Name:DIVINE GRACE
Middle Name:MEER
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIVINE GRACE
Other - Middle Name:MANAOG
Other - Last Name:MEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3945
Mailing Address - Country:US
Mailing Address - Phone:718-310-0892
Mailing Address - Fax:
Practice Address - Street 1:1501 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:718-310-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist