Provider Demographics
NPI:1861850547
Name:ADVANCED DOWNTOWN AQUATIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ADVANCED DOWNTOWN AQUATIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-343-9755
Mailing Address - Street 1:105 W HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1286
Mailing Address - Country:US
Mailing Address - Phone:989-343-9755
Mailing Address - Fax:989-343-9955
Practice Address - Street 1:105 W HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1286
Practice Address - Country:US
Practice Address - Phone:989-343-9755
Practice Address - Fax:989-343-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB2267W261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy