Provider Demographics
NPI:1962412932
Name:WATER WORKS AQUATIC PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:WATER WORKS AQUATIC PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-702-0110
Mailing Address - Street 1:510 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1454
Mailing Address - Country:US
Mailing Address - Phone:330-702-0110
Mailing Address - Fax:330-702-0510
Practice Address - Street 1:999 TRAIL TERRACE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2329
Practice Address - Country:US
Practice Address - Phone:239-649-2222
Practice Address - Fax:239-649-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4645261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRJ5OtherBC/BS
FLRJ5OtherBC/BS