Provider Demographics
NPI:1205849643
Name:AQUAHAB, LP
Entity Type:Organization
Organization Name:AQUAHAB, LP
Other - Org Name:AQUAHAB PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-677-0400
Mailing Address - Street 1:5 ESTERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4001
Mailing Address - Country:US
Mailing Address - Phone:215-677-0400
Mailing Address - Fax:215-671-1837
Practice Address - Street 1:5 ESTERBROOK LN
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4001
Practice Address - Country:US
Practice Address - Phone:215-677-0400
Practice Address - Fax:215-671-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316643Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER