Organization
CUSTOM AQUATIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M HAEFNER PTA (OWNER)
(314) 313-3177
Entity
Organization
Contact information
Practice address
1528 LOCUST ST, SAINT LOUIS, MO 63103-1816
(314) 313-3177
Mailing address
3951 DOVER PL, SAINT LOUIS, MO 63116-3213
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/01/2024
Last updated
02/13/2024
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