Provider Demographics
NPI:1679051437
Name:MARIANNA PHYSICAL & AQUATIC THERAPY LLC
Entity Type:Organization
Organization Name:MARIANNA PHYSICAL & AQUATIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KALIEGH
Authorized Official - Middle Name:PAYNE
Authorized Official - Last Name:LAUREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-596-0218
Mailing Address - Street 1:4285 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2919
Mailing Address - Country:US
Mailing Address - Phone:850-596-0218
Mailing Address - Fax:866-630-5149
Practice Address - Street 1:4285 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2919
Practice Address - Country:US
Practice Address - Phone:850-482-0080
Practice Address - Fax:866-630-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty