Provider Demographics
NPI:1932664919
Name:AQUILO SPORTS
Entity Type:Organization
Organization Name:AQUILO SPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP SALES & MARKETING
Authorized Official - Prefix:
Authorized Official - First Name:JOHN-PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-523-0378
Mailing Address - Street 1:620 S 3RD ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2448
Mailing Address - Country:US
Mailing Address - Phone:502-523-0378
Mailing Address - Fax:
Practice Address - Street 1:620 S 3RD ST STE 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2448
Practice Address - Country:US
Practice Address - Phone:502-523-0378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies