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General NPI Number Information
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NPI Number | 1962412932
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Entity Type | Organization
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Legal Business Name | WATER WORKS AQUATIC PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 999 TRAIL TERRACE DR SUITE A
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City | NAPLES
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State | FL
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Zip | 34103-2329
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Country | US
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Telephone | 239-649-2222
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Fax | 239-649-0522
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Provider Business Mailing Address
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Address Line | 510 W MAIN ST STE B
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City | CANFIELD
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State | OH
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Zip | 44406-1454
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Country | US
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Telephone | 330-702-0110
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Fax | 330-702-0510
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. RENEE HALFHILL
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Credential |
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Telephone | 330-702-0110
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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 | HCC4645
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License Number State | FL
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