Provider Demographics
NPI:1932927860
Name:LITERAL, JOSE DIVINAGRACIA (DPT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DIVINAGRACIA
Last Name:LITERAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11057 BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2407
Mailing Address - Country:US
Mailing Address - Phone:317-531-9790
Mailing Address - Fax:
Practice Address - Street 1:401 S GLENOAKS BLVD STE 212
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2750
Practice Address - Country:US
Practice Address - Phone:747-286-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist