Provider Demographics
NPI:1700218872
Name:SERENITY THERAPIES/H3O AQUATICS
Entity Type:Organization
Organization Name:SERENITY THERAPIES/H3O AQUATICS
Other - Org Name:H3O AQUATICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:615-594-0064
Mailing Address - Street 1:PO BOX 1893
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1893
Mailing Address - Country:US
Mailing Address - Phone:615-889-4413
Mailing Address - Fax:615-841-4829
Practice Address - Street 1:236 ROBERT ROSE DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-6373
Practice Address - Country:US
Practice Address - Phone:615-889-4413
Practice Address - Fax:615-841-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261Q00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy