NPIMap

Organization Active NPI

Aquatic Health and Rehabilitation Services Inc

  • Physical Therapist
  • Merritt Island, FL
National Provider Identifier
1831294412
Registry record updated Jul 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
AQUATIC HEALTH AND REHABILITATION SERVICES INC
Practice address
595 N Courtenay Pkwy
#203
Merritt Island, FL 32953-4851
Phone
(321) 453-8484
Fax
(321) 453-8448
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2008

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

Authorized official

Name
Tereasa Dianne Shepherd, P.T.,MSHANPI 1780789420
Title
President
Phone
(321) 453-8484

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

595 N Courtenay Pkwy
#203
Merritt Island, FL 32953-4851

Mailing address

PO Box 541210
Merritt Island, FL 32954-1210
Phone (321) 453-8484

Other identifiers 5

IdentifierTypeStateIssuer
888029800MedicaidFL
9725170OtherFLGHI
7742686OtherFLAETNA
Y904DOtherFLBCBS
P00060639OtherGARAILROAD MEDICARE

Other names 1

  • Aquatic Health and Rehab Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081010000153 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294803755 Receives reassigned benefits from 8 practitioners
Practice locations: Melbourne, FL; Merritt Island, FL

National Provider Directory

National Provider Directory

Locations

595 N Courtenay Pkwy
Ste 203
Merritt Island, FL 32953
Phone (321) 453-8484

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216857600000",
    "number": "1831294412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 541210",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329541210",
            "telephone_number": "321-453-8484",
            "fax_number": "321-453-8448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 N COURTENAY PKWY",
            "address_2": "#203",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534851",
            "telephone_number": "321-453-8484",
            "fax_number": "321-453-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUATIC HEALTH AND REHABILITATION SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2008-07-24",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "TEREASA",
        "authorized_official_middle_name": "DIANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-453-8484",
        "authorized_official_credential": "P.T.,MSHA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "888029800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "9725170",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7742686",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y904D",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00060639",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aquatic Health and Rehab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; 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.