Provider Demographics
NPI:1053349647
Name:AQUATHERAPIES, LLC
Entity type:Organization
Organization Name:AQUATHERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-668-4449
Mailing Address - Street 1:614 CARRIAGE HOUSE DR STE E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4238
Mailing Address - Country:US
Mailing Address - Phone:731-668-4449
Mailing Address - Fax:
Practice Address - Street 1:614 CARRIAGE HOUSE DR STE E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4238
Practice Address - Country:US
Practice Address - Phone:731-668-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN161883OtherBETTER HEALTH PROVIDER #
TN27977OtherUAHC-OMNI PROVIDER #
TN0446672Medicaid
TNBCBSOther4091400
TN332979OtherTLC PROVIDER #
TN4091400OtherTN CARE SELECT PROVIDER #
TNBCBSOther4091400
TN161883OtherBETTER HEALTH PROVIDER #