Healthcare Provider Details

I. General information

NPI: 1962412932
Provider Name (Legal Business Name): WATER WORKS AQUATIC PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 TRAIL TERRACE DR SUITE A
NAPLES FL
34103-2329
US

IV. Provider business mailing address

510 W MAIN ST STE B
CANFIELD OH
44406-1454
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-2222
  • Fax: 239-649-0522
Mailing address:
  • Phone: 330-702-0110
  • Fax: 330-702-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberHCC4645
License Number StateFL

VIII. Authorized Official

Name: MRS. RENEE HALFHILL
Title or Position: OWNER/CEO
Credential:
Phone: 330-702-0110