Provider Demographics
NPI:1295849990
Name:AQUATIC REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:AQUATIC REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-793-5525
Mailing Address - Street 1:10567 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4451
Mailing Address - Country:US
Mailing Address - Phone:513-793-5525
Mailing Address - Fax:513-984-1178
Practice Address - Street 1:10567 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4451
Practice Address - Country:US
Practice Address - Phone:513-793-5525
Practice Address - Fax:513-984-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
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
OH2456917Medicaid
OHPT180OtherHUMANA/CHOICE CARE
OH64-00167OtherUNITED HEALTHCARE
OH000000014867OtherANTHEM
OH=========00OtherBUREAU WORKERS COMPENSATI
OH64-00167OtherUNITED HEALTHCARE