Provider Demographics
NPI:1629033121
Name:NEW HORIZONS PHYSICAL THERAPY, LTD.
Entity Type:Organization
Organization Name:NEW HORIZONS PHYSICAL THERAPY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMORA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-8766
Mailing Address - Street 1:4800 S WHITE MOUNTAIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7876
Mailing Address - Country:US
Mailing Address - Phone:928-537-8766
Mailing Address - Fax:928-537-8786
Practice Address - Street 1:4800 S WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7876
Practice Address - Country:US
Practice Address - Phone:928-537-8766
Practice Address - Fax:928-537-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2451261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ64000Medicare PIN