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General NPI Number Information
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NPI Number | 1427115641
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Entity Type | Organization
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Legal Business Name | AQUATIC THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 CARRIE MITCHELL RD
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City | CARRIERE
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State | MS
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Zip | 39426
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Country | US
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Telephone | 985-774-1155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 153
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City | BUSH
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State | LA
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Zip | 70431-0153
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DANA N ROSSER
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Credential | PT
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Telephone | 985-774-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT4166
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License Number State | MS
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