Provider Demographics
NPI:1285676528
Name:MEDLEY SWIM SYSTEMS INC
Entity Type:Organization
Organization Name:MEDLEY SWIM SYSTEMS INC
Other - Org Name:LAKEWAY AQUATIC THERAPY & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARKER
Authorized Official - Middle Name:F
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:512-261-0620
Mailing Address - Street 1:PO BOX 342348
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-0040
Mailing Address - Country:US
Mailing Address - Phone:512-261-0620
Mailing Address - Fax:512-261-9441
Practice Address - Street 1:1927 LOHMANS CROSSING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-5239
Practice Address - Country:US
Practice Address - Phone:512-261-0620
Practice Address - Fax:512-261-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00725XMedicare ID - Type UnspecifiedGROUP NUMBER