Provider Demographics
NPI:1245965342
Name:COLORADO RIVER PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:COLORADO RIVER PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HANZ
Authorized Official - Middle Name:
Authorized Official - Last Name:TABORA
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:928-248-0444
Mailing Address - Street 1:1510 E WAGON WHEEL LN STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6698
Mailing Address - Country:US
Mailing Address - Phone:928-248-0444
Mailing Address - Fax:
Practice Address - Street 1:1510 E WAGON WHEEL LN
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6697
Practice Address - Country:US
Practice Address - Phone:928-788-3333
Practice Address - Fax:928-788-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty