Provider Demographics
NPI:1427115641
Name:AQUATIC THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:AQUATIC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-774-1155
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:BUSH
Mailing Address - State:LA
Mailing Address - Zip Code:70431-0153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CARRIE MITCHELL RD
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426
Practice Address - Country:US
Practice Address - Phone:985-774-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4166261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy