1962412932 NPI number — WATER WORKS AQUATIC PHYSICAL THERAPY INC

Table of content: (NPI 1962412932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962412932 NPI number — WATER WORKS AQUATIC PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WATER WORKS AQUATIC PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962412932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 W MAIN ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44406-1454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-702-0110
Provider Business Mailing Address Fax Number:
330-702-0510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 TRAIL TERRACE DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34103-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-649-2222
Provider Business Practice Location Address Fax Number:
239-649-0522
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALFHILL
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
330-702-0110

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  HCC4645 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RJ5 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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