Organization
AQUAHAB, LP
Active
Other names
AQUAHAB PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH SIEDLECKI (BILLING SUPERVISOR)
(215) 677-0400
Entity
Organization
Contact information
Practice address
3600 GRANT AVE, PHILA, PA 19114-2630
(215) 677-0400
(215) 671-1837
Mailing address
3600 GRANT AVE, PHILA, PA 19114-2630
(215) 677-0400
(215) 671-1837
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
DN002660
PA
133NN1002X
Nutrition Education Nutritionist
DN003739
PA
133NN1002X
Nutrition Education Nutritionist
DN003889
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2864330000
INDEPENDENCE BLUE CROSS
PA
Enumeration date
12/12/2008
Last updated
12/12/2008
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