Organization
INDIGO AQUATIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY O'CONNOR DPT (SOLE MEMBER)
(973) 949-3927
Entity
Organization
Contact information
Practice address
599 GOFFLE HILL RD, HAWTHORNE, NJ 07506-3037
(973) 949-3927
Mailing address
599 GOFFLE HILL RD, HAWTHORNE, NJ 07506-3037
(973) 949-3927
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01348800
NJ
Other
Enumeration date
08/20/2013
Last updated
01/24/2014
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