Provider Demographics
NPI:1376944553
Name:ABSOLUTE PHYSICAL & AQUATTIC THERAPY LLC
Entity Type:Organization
Organization Name:ABSOLUTE PHYSICAL & AQUATTIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:LAUREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-596-0218
Mailing Address - Street 1:1695 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-5992
Mailing Address - Country:US
Mailing Address - Phone:850-638-3387
Mailing Address - Fax:850-415-1967
Practice Address - Street 1:625 W BALDWIN RD STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3359
Practice Address - Country:US
Practice Address - Phone:850-628-3393
Practice Address - Fax:850-415-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty