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NPI Code Detail

MEDICARE: CITY OF MIDLAND AQUATICS INC

MEDICARE: CITY OF MIDLAND AQUATICS INC
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
1225100000XPhysical TherapistTX

General Provider Information

NPI Number : 1881705747
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY OF MIDLAND AQUATICS INC
Provider Business Mailing Address
First Line : 3003 N A ST
Second Line :
City : MIDLAND
State : TX
Zip : 79705-5304
Country : US
Telephone Number : 432-684-7755
Fax Number : 432-684-7962
Provider Business Practice Location Address
First Line : 3003 N A ST
Second Line :
City : MIDLAND
State : TX
Zip : 79705-5304
Country : US
Telephone Number : 432-684-7755
Fax Number : 432-684-7962
Authorized Official
Title or Position : PRESIDENT
Name : MR. BRAD M. SWENDIG
Credential :
Telephone Number : 432-684-7755
Provider Enumeration Date : 08/31/2006
Last Update Date : 09/14/2007

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Directions to “CITY OF MIDLAND AQUATICS INC ” Practice Location

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