Provider Demographics
NPI:1013087576
Name:HORMAN, PHARES BRIGGS (PT)
Entity Type:Individual
Prefix:
First Name:PHARES
Middle Name:BRIGGS
Last Name:HORMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BRIGGS
Other - Middle Name:
Other - Last Name:HORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3456 E 17TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6757
Mailing Address - Country:US
Mailing Address - Phone:208-523-0030
Mailing Address - Fax:
Practice Address - Street 1:3456 E 17TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6757
Practice Address - Country:US
Practice Address - Phone:208-523-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDTD207OtherBLUE CROSS INDIVIDUAL #
ID000010152190OtherBLUE SHIELD INDIV. NUMBER
ID000010152186OtherBLUE SHIELD GROUP NUMBER
ID8M467OtherBLUE CROSS GROUP NUMBER
ID000010152186OtherBLUE SHIELD GROUP NUMBER