Organization
PHYSCIAL AND AQUATIC THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN CHRISTOPHER KAZALAS MPT (PHYSICAL THERAPIST/OWNER)
(304) 235-4300
Entity
Organization
Contact information
Practice address
54 W 3RD AVE, WILLIAMSON, WV 25661-3508
(304) 235-4300
(304) 235-0176
Mailing address
54 W 3RD AVE, WILLIAMSON, WV 25661-3508
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001711463
BLUE CROSS/BLUE SHIELD GP
—
01
—
001723120
PIN #
—
Enumeration date
08/28/2006
Last updated
10/06/2008
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