Healthcare Provider Details

I. General information

NPI: 1831294412
Provider Name (Legal Business Name): AQUATIC HEALTH AND REHABILITATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 N COURTENAY PKWY #203
MERRITT ISLAND FL
32953-4851
US

IV. Provider business mailing address

PO BOX 541210
MERRITT ISLAND FL
32954-1210
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-8484
  • Fax: 321-453-8448
Mailing address:
  • Phone: 321-453-8484
  • Fax: 321-453-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TEREASA DIANNE SHEPHERD
Title or Position: PRESIDENT
Credential: P.T.,MSHA
Phone: 321-453-8484