Provider Demographics
NPI:1265860456
Name:HUMBOLDT PHYSCIAL THERAPY & FITNESS
Entity Type:Organization
Organization Name:HUMBOLDT PHYSCIAL THERAPY & FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILLYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:775-623-4813
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89446-0170
Mailing Address - Country:US
Mailing Address - Phone:775-560-8399
Mailing Address - Fax:
Practice Address - Street 1:3300 TRADERS WAY STE C
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3658
Practice Address - Country:US
Practice Address - Phone:775-623-4813
Practice Address - Fax:775-623-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV660261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy