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General NPI Number Information
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NPI Number | 1649485723
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Entity Type | Organization
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Legal Business Name | USA AQUATIC FITNESS, INC.
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 209 E BASELINE RD SUITE E101
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City | TEMPE
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State | AZ
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Zip | 85283-1269
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Country | US
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Telephone | 480-892-0479
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Fax | 480-507-3318
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Provider Business Mailing Address
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Address Line | PO BOX 644
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City | GILBERT
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State | AZ
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Zip | 85299-0644
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Country | US
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Telephone | 480-892-0479
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Fax | 480-507-3318
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Authorized Official
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Title or Position | PRESIDENT
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Name | TOM ELLSWORTH
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Credential |
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Telephone | 480-892-0479
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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 |
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License Number State |
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