Provider Demographics
NPI:1336187715
Name:NEURO AQUATIC REHABILITATION CENTER
Entity Type:Organization
Organization Name:NEURO AQUATIC REHABILITATION CENTER
Other - Org Name:AQUATIC NEUROLOGICAL REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-326-2782
Mailing Address - Street 1:2919 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2717
Mailing Address - Country:US
Mailing Address - Phone:520-326-2782
Mailing Address - Fax:520-326-9552
Practice Address - Street 1:2919 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2717
Practice Address - Country:US
Practice Address - Phone:520-326-2782
Practice Address - Fax:520-326-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ983511Medicaid