Provider Demographics
NPI:1740044908
Name:H2O-4-LIFE AQUATIC AND BALANCE REHAB LLC
Entity type:Organization
Organization Name:H2O-4-LIFE AQUATIC AND BALANCE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSALISBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-539-2403
Mailing Address - Street 1:3545 MASSINI AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-2412
Mailing Address - Country:US
Mailing Address - Phone:941-539-2403
Mailing Address - Fax:
Practice Address - Street 1:108 BELLA VERDE BLVD
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1100
Practice Address - Country:US
Practice Address - Phone:941-539-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty