Provider Demographics
NPI:1891025656
Name:PHILLIPS THERAPY INCORPORATED
Entity Type:Organization
Organization Name:PHILLIPS THERAPY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HORA
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:208-705-7868
Mailing Address - Street 1:729 PINE MOUNTAIN VIEW DRIVE
Mailing Address - Street 2:PO BOX 761
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455
Mailing Address - Country:US
Mailing Address - Phone:208-705-7868
Mailing Address - Fax:208-787-0946
Practice Address - Street 1:73 NORTH MAIN ST.,
Practice Address - Street 2:SUITE 3
Practice Address - City:VICTOR
Practice Address - State:ID
Practice Address - Zip Code:83455
Practice Address - Country:US
Practice Address - Phone:208-705-7868
Practice Address - Fax:208-787-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty