Provider Demographics
NPI:1831178748
Name:AQUATIC THERAPY OF NEW ENGLAND
Entity type:Organization
Organization Name:AQUATIC THERAPY OF NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:THEBERGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-658-5577
Mailing Address - Street 1:40 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1050
Mailing Address - Country:US
Mailing Address - Phone:978-658-5577
Mailing Address - Fax:978-658-5587
Practice Address - Street 1:40 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1050
Practice Address - Country:US
Practice Address - Phone:978-658-5577
Practice Address - Fax:978-658-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0196Medicare ID - Type Unspecified