Healthcare Provider Details

I. General information

NPI: 1831178748
Provider Name (Legal Business Name): AQUATIC THERAPY OF NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TURNPIKE RD
IPSWICH MA
01938-1050
US

IV. Provider business mailing address

40 TURNPIKE RD
IPSWICH MA
01938-1050
US

V. Phone/Fax

Practice location:
  • Phone: 978-658-5577
  • Fax: 978-658-5587
Mailing address:
  • Phone: 978-658-5577
  • Fax: 978-658-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DALE THEBERGE
Title or Position: OWNER
Credential:
Phone: 978-658-5577