Organization
USA AQUATIC FITNESS, INC.
Active
Other names
Next Level Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
TOM ELLSWORTH (PRESIDENT)
(480) 892-0479
Entity
Organization
Contact information
Practice address
209 E BASELINE RD, SUITE E101, TEMPE, AZ 85283-1269
(480) 892-0479
(480) 507-3318
Mailing address
PO BOX 644, GILBERT, AZ 85299-0644
(480) 892-0479
(480) 507-3318
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0299220
BCBS PROVIDER ID
AZ
Enumeration date
05/11/2007
Last updated
08/22/2020
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