NPIMap

Organization Active NPI

Aquatic Physical Therapy & Beyond, LLC

  • Physical Therapist
  • Raleigh, NC
National Provider Identifier
1861462558
Registry record updated Apr 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8948 Issued in NC
Legal business name
AQUATIC PHYSICAL THERAPY & BEYOND, LLC
Practice address
8305 Falls of Neuse Rd
Ste. 102
Raleigh, NC 27615-3546
Phone
(919) 870-4444
Fax
(919) 870-4447
NPI assigned
Jan 25, 2006
Last updated
Apr 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2018

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

Authorized official

Name
Kristine OlivottiNPI 1598735276
Title
Ceo
Phone
(919) 870-4444

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 8948 NC Primary

Addresses

Primary practice location

8305 Falls of Neuse Rd
Ste. 102
Raleigh, NC 27615-3546

Mailing address

8305 Falls of Neuse Rd
Ste. 102
Raleigh, NC 27615-3546
Phone (919) 870-4444

Other identifiers 3

IdentifierTypeStateIssuer
016K6OtherNCBLUE CROSS BLUE SHIELD ID
7211687MedicaidNC
DD0417OtherNCRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040712000662 NC Part B Supplier - Clinic/Group Practice 2668450008 Receives reassigned benefits from 9 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

8305 Falls of Neuse Rd
Ste 102
Raleigh, NC 27615
Phone (919) 870-4444

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522713600000",
    "number": "1861462558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8305 FALLS OF NEUSE RD",
            "address_2": "STE. 102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276153546",
            "telephone_number": "919-870-4444",
            "fax_number": "919-870-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8305 FALLS OF NEUSE RD",
            "address_2": "STE. 102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276153546",
            "telephone_number": "919-870-4444",
            "fax_number": "919-870-4447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUATIC PHYSICAL THERAPY & BEYOND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2018-04-03",
        "status": "A",
        "authorized_official_last_name": "OLIVOTTI",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-870-4444"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "8948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "016K6",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7211687",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD0417",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2018; 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.