MEDICARE: SERENITY THERAPIES/H3O AQUATICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		TN
2	261Q00000X	Clinic/Center		TN

General Provider Information

NPI Number	:	1700218872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY THERAPIES/H3O AQUATICS

Provider Business Mailing Address
First Line	:	PO BOX 1893
Second Line	:
City	:	GALLATIN
State	:	TN
Zip	:	37066-1893
Country	:	US
Telephone Number	:	615-889-4413
Fax Number	:	615-841-4829

Provider Business Practice Location Address
First Line	:	236 ROBERT ROSE DR
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37129-6373
Country	:	US
Telephone Number	:	615-889-4413
Fax Number	:	615-841-4829

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTA SIMPSON
Credential	:	MED
Telephone Number	:	615-594-0064

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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