Healthcare Provider Details

I. General information

NPI: 1437421211
Provider Name (Legal Business Name): AQUATIC N WRITING REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12355 W COCOPAH ST
AVONDALE AZ
85323-3120
US

IV. Provider business mailing address

12355 W COCOPAH ST
AVONDALE AZ
85323-3120
US

V. Phone/Fax

Practice location:
  • Phone: 480-213-4682
  • Fax:
Mailing address:
  • Phone: 480-213-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. MICHELLE TURNER
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 480-213-4682