Healthcare Provider Details

I. General information

NPI: 1639175474
Provider Name (Legal Business Name): REHABILITATION AQUATICS AND PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 CENTRAL PARK W STE A
TOLEDO OH
43617-1088
US

IV. Provider business mailing address

3130 CENTRAL PARK W STE A
TOLEDO OH
43617-1088
US

V. Phone/Fax

Practice location:
  • Phone: 419-841-9622
  • Fax: 419-843-8288
Mailing address:
  • Phone: 419-841-9622
  • Fax: 419-843-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01872
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number03101
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03396
License Number StateOH

VIII. Authorized Official

Name: MRS. CINDY MARIE BINKLEY
Title or Position: ADMINISTRATOR
Credential: RKT
Phone: 419-841-9622