Healthcare Provider Details

I. General information

NPI: 1801993019
Provider Name (Legal Business Name): AQUATIC FITNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12539 OLIVE BLVD
SAINT LOUIS MO
63141-6311
US

IV. Provider business mailing address

12539 OLIVE BLVD
SAINT LOUIS MO
63141-6311
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-2006
  • Fax: 314-205-2241
Mailing address:
  • Phone: 314-205-2006
  • Fax: 314-205-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number01821
License Number StateMO

VIII. Authorized Official

Name: JANET PRATT
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: P.T.
Phone: 314-205-2006