Healthcare Provider Details

I. General information

NPI: 1093517716
Provider Name (Legal Business Name): CRESTVIEW PHYSICAL AND AQUATIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 04/15/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 BROOKMEADE DR
CRESTVIEW FL
32539-6029
US

IV. Provider business mailing address

577 BROOKMEADE DR
CRESTVIEW FL
32539-6029
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-7466
  • Fax: 850-682-6591
Mailing address:
  • Phone: 850-682-7466
  • Fax: 850-682-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DARLENE ROBBINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-682-7466