Provider Demographics
NPI:1174759245
Name:AQUATIC THERAPY AND WELLNESS P.C.
Entity type:Organization
Organization Name:AQUATIC THERAPY AND WELLNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOYT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:847-428-5116
Mailing Address - Street 1:105 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2315
Mailing Address - Country:US
Mailing Address - Phone:708-670-4216
Mailing Address - Fax:847-428-7740
Practice Address - Street 1:105 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2315
Practice Address - Country:US
Practice Address - Phone:708-670-4216
Practice Address - Fax:847-428-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-005319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty