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General NPI Number Information
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NPI Number | 1265776017
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Entity Type | Organization
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Legal Business Name | LIVING WATER WELLNESS AND THERAPY LLC
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Dates
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Enumeration Date | 11/17/2012
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 6643 LAGOON WAY APARTMENT 4
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City | PORTAGE
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State | IN
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Zip | 46368-4277
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Country | US
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Telephone | 248-210-8805
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Fax |
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Provider Business Mailing Address
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Address Line | 7895 BROADWAY STE D
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5529
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Country | US
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Telephone | 213-200-2163
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES ARIAN KIRKLAND
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Credential | P.T., D.P.T., D.M.T.
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Telephone | 248-210-8805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 05010477A
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License Number State | IN
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