Provider Demographics
NPI:1912204983
Name:AQUAWORX
Entity Type:Organization
Organization Name:AQUAWORX
Other - Org Name:FYZICAL THERAPY & BALANCE CENTERS OF DELMARVA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-208-1525
Mailing Address - Street 1:11204 RACETRACK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3370
Mailing Address - Country:US
Mailing Address - Phone:410-208-1525
Mailing Address - Fax:
Practice Address - Street 1:11204 RACETRACK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3367
Practice Address - Country:US
Practice Address - Phone:410-208-1525
Practice Address - Fax:410-208-1527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-27
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty