| Divine Dela Vega Autrey, PT | |
|
470 Old Country Rd Se, Palm Bay, FL 32909-6906 | |
| (561) 201-2240 | |
| Not Available |
| Full Name | Divine Dela Vega Autrey |
|---|---|
| Gender | Female |
| Speciality | Physical Therapist |
| Location | 470 Old Country Rd Se, Palm Bay, Florida |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518212380 | NPI | - | NPPES |
| PT31959 | Other | FL | PT LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT31959 (Tennessee) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Dela Vega Autrey, PT 470 Old Country Rd Se, Palm Bay, FL 32909-6906 Ph: (561) 201-2240 | Divine Dela Vega Autrey, PT 470 Old Country Rd Se, Palm Bay, FL 32909-6906 Ph: (561) 201-2240 |
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