Custom Aquatic Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

CUSTOM AQUATIC THERAPY LLC

Practice address

1528 Locust St
Saint Louis, MO 63103-1816

Phone

(314) 313-3177

NPI assigned

Jan 1, 2024

Organization subpart

No

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

Authorized official

Name

Jennifer M Haefner, PTANPI 1205603107

Title

Owner

Phone

(314) 313-3177

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jennifer Haefner, PTA

  • Physical Therapy Assistant
  • Clayton, MO
  • NPI 1205603107
  NPD Authorized official

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

{
    "created_epoch": "1704067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1851160816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3951 DOVER PL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631163213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 LOCUST ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031816",
            "telephone_number": "314-313-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM AQUATIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-01",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "HAEFNER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-313-3177",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Noelle Cushman
• Sarah Cust, MSC-SLP, CCC-SLP
• Philip L Custer, MD
• Sophia Custer, P.A.
• Alfredo Custodio, M.D.
• Custom Dental Management
• Custom Joy LLC
• Custom Medical Solutions Inc
• Joseph V Cusumano, MD
• Laura M Cusumano, RD

• Physical Therapist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.