Living Water Wellness and Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

05010477A Issued in IN

Legal business name

LIVING WATER WELLNESS AND THERAPY LLC

Practice address

6643 Lagoon Way
Apartment 4
Portage, IN 46368-4277

Phone

(248) 210-8805

NPI assigned

Nov 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Arian Kirkland, P.T., D.P.T., D.M.T.NPI 1467525857

Title

Owner

Phone

(248) 210-8805

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles A Kirkland, PT, DPT, DMT

  • Orthopedic Physical Therapist
  • Little Rock, AR
  • NPI 1467525857

  IN

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740009600000",
    "number": "1265776017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7895 BROADWAY STE D",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105529",
            "telephone_number": "213-200-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6643 LAGOON WAY",
            "address_2": "APARTMENT 4",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684277",
            "telephone_number": "248-210-8805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATER WELLNESS AND THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-17",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "KIRKLAND",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ARIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-210-8805",
        "authorized_official_credential": "P.T., D.P.T., D.M.T."
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IN",
            "license": "05010477A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Lettman, IBCLC
• Kathleen Levandoski, ATC/L
• Taylor Marie Lewis, LCSW
• Terry Louise Lewis, RPH
• Kenya Lile
• Rick D Logan, LPT
• Jaela Loggins
• Rebecca A. Long, O.D.
• Shawn Eric Lovett, OD
• Sharon Shaw Lowe, MA,LCPC

• Physical Therapy Clinic/Center in Portage, IN
• Providers in Portage, IN by specialty
• Physical Therapy Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.