Indigo Aquatic Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01348800 Issued in NJ

Legal business name

INDIGO AQUATIC THERAPY LLC

Practice address

599 Goffle Hill Rd
Hawthorne, NJ 07506-3037

Phone

(973) 949-3927

NPI assigned

Aug 20, 2013

Organization subpart

No

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

Authorized official

Name

Stacey O'Connor, DPT

Title

Sole Member

Phone

(973) 949-3927

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390521600000",
    "number": "1972936417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 GOFFLE HILL RD",
            "city": "HAWTHORNE",
            "state": "NJ",
            "postal_code": "075063037",
            "telephone_number": "973-949-3927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "599 GOFFLE HILL RD",
            "city": "HAWTHORNE",
            "state": "NJ",
            "postal_code": "075063037",
            "telephone_number": "973-949-3927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO AQUATIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-20",
        "last_updated": "2014-01-24",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "973-949-3927",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01348800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Hawthorne, NJ
• Providers in Hawthorne, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; 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.