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
State | License ID | Taxonomies |
---|---|---|
NV | NV660 | 261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |