# INDIGO AQUATIC THERAPY LLC

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

## Provider details

- **NPI number:** 1972936417
- **Authorized official:** STACEY O'CONNOR DPT (SOLE MEMBER)
- **Authorized official phone:** (973) 949-3927

## Contact information

- **Practice address:** 599 GOFFLE HILL RD, HAWTHORNE, NJ 07506-3037
- **Practice address phone:** (973) 949-3927
- **Mailing address:** 599 GOFFLE HILL RD, HAWTHORNE, NJ 07506-3037
- **Mailing address phone:** (973) 949-3927

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 40QA01348800 | NJ | Yes |

## Other

- **Enumeration date:** 08/20/2013
- **Last updated:** 01/24/2014