Provider Demographics
NPI:1760574149
Name:TRANSYLVANIA AQUATIC PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:TRANSYLVANIA AQUATIC PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-877-3877
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-1531
Mailing Address - Country:US
Mailing Address - Phone:828-877-3877
Mailing Address - Fax:828-877-5160
Practice Address - Street 1:COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-877-3877
Practice Address - Fax:828-877-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
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
NC013FUOtherBLUE CROSS BLUE SHIELD NC
NC013FUOtherBLUE CROSS BLUE SHIELD NC