Provider Demographics
NPI:1861462558
Name:AQUATIC PHYSICAL THERAPY & BEYOND, LLC
Entity type:Organization
Organization Name:AQUATIC PHYSICAL THERAPY & BEYOND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-870-4444
Mailing Address - Street 1:8305 FALLS OF NEUSE RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3546
Mailing Address - Country:US
Mailing Address - Phone:919-870-4444
Mailing Address - Fax:919-870-4447
Practice Address - Street 1:8305 FALLS OF NEUSE RD
Practice Address - Street 2:STE. 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3546
Practice Address - Country:US
Practice Address - Phone:919-870-4444
Practice Address - Fax:919-870-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016K6OtherBLUE CROSS BLUE SHIELD ID
NC7211687Medicaid
NCDD0417OtherRAILROAD MEDICARE
NC016K6OtherBLUE CROSS BLUE SHIELD ID