# MARIANNA PHYSICAL & AQUATIC THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679051437
- **Authorized official:** MS. KALIEGH PAYNE LAUREL (OWNER)
- **Authorized official phone:** (850) 596-0218

## Contact information

- **Practice address:** 4285 LAFAYETTE ST, MARIANNA, FL 32446-2919
- **Practice address phone:** (850) 482-0080
- **Practice address fax:** (866) 630-5149
- **Mailing address:** 4285 LAFAYETTE ST, MARIANNA, FL 32446-2919
- **Mailing address phone:** (850) 596-0218
- **Mailing address fax:** (866) 630-5149

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/03/2018
- **Last updated:** 09/10/2021