Provider Demographics
NPI:1699817908
Name:NEW HORIZONS PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:NEW HORIZONS PHYSICAL THERAPY, PC
Other - Org Name:NEW HORIZONS PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY,CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MONDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MSRS, CLT-LANA
Authorized Official - Phone:858-764-2409
Mailing Address - Street 1:169 SAXONY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6778
Mailing Address - Country:US
Mailing Address - Phone:760-230-6472
Mailing Address - Fax:760-230-6473
Practice Address - Street 1:169 SAXONY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6778
Practice Address - Country:US
Practice Address - Phone:760-230-6472
Practice Address - Fax:760-230-6473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT200260OtherBLUE SHIELD OF CA
CA5306540001OtherMEDICARE DME SOUTHERN CA
CAPT20026AMedicare ID - Type Unspecified
CA5306540001OtherMEDICARE DME SOUTHERN CA
Q13339Medicare UPIN