Provider Demographics
NPI:1093517716
Name:CRESTVIEW PHYSICAL AND AQUATIC THERAPY LLC
Entity type:Organization
Organization Name:CRESTVIEW PHYSICAL AND AQUATIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-682-7466
Mailing Address - Street 1:577 BROOKMEADE DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-6029
Mailing Address - Country:US
Mailing Address - Phone:850-682-7466
Mailing Address - Fax:850-682-6591
Practice Address - Street 1:577 BROOKMEADE DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6029
Practice Address - Country:US
Practice Address - Phone:850-682-7466
Practice Address - Fax:850-682-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty