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General NPI Number Information
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NPI Number | 1093253361
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Entity Type | Organization
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Legal Business Name | AQUATIC-N-WRITING REHAD
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 12355 WEST COCOPAH STREET
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City | AVONDALE
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State | AZ
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Zip | 85323
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Country | US
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Telephone | 480-213-4682
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Fax |
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Provider Business Mailing Address
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Address Line | 12355 WEST COCOPAH STREET
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City | AVONDALE
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State | AZ
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Zip | 85323
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Country | US
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Telephone | 480-213-4682
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE TURNER
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Credential | DPT
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Telephone | 480-213-4682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 06659
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License Number State | AZ
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