Basic Information
| Provider Information | |||||||||
| NPI: | 1053349647 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AQUATHERAPIES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 614 CARRIAGE HOUSE DR STE E | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383054238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316684449 | ||||||||
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| Practice Location | |||||||||
| Address1: | 614 CARRIAGE HOUSE DR STE E | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383054238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316684449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARDIN | ||||||||
| AuthorizedOfficialFirstName: | SANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7316684449 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 161883 | 01 | TN | BETTER HEALTH PROVIDER # | OTHER | 27977 | 01 | TN | UAHC-OMNI PROVIDER # | OTHER | 0446672 | 05 | TN | MEDICAID | BCBS | 01 | TN | 4091400 | OTHER | 332979 | 01 | TN | TLC PROVIDER # | OTHER | 4091400 | 01 | TN | TN CARE SELECT PROVIDER # | OTHER |