Provider Demographics
NPI:1548014533
Name:SOUTH WALTON THERAPY CONTRACTING LLC
Entity type:Organization
Organization Name:SOUTH WALTON THERAPY CONTRACTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE ANN
Authorized Official - Middle Name:LANCETA
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-980-8425
Mailing Address - Street 1:99 EAGLE BAY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-8370
Mailing Address - Country:US
Mailing Address - Phone:850-254-1128
Mailing Address - Fax:866-728-7817
Practice Address - Street 1:99 EAGLE BAY LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-8370
Practice Address - Country:US
Practice Address - Phone:850-254-1128
Practice Address - Fax:866-728-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty