Provider Demographics
NPI:1629816582
Name:AMAZING GRACE EQUINE THERAPY
Entity type:Organization
Organization Name:AMAZING GRACE EQUINE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:317-518-2272
Mailing Address - Street 1:12956 N SLIDEOFF RD
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8595
Mailing Address - Country:US
Mailing Address - Phone:317-518-2272
Mailing Address - Fax:
Practice Address - Street 1:12956 N SLIDEOFF RD
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8595
Practice Address - Country:US
Practice Address - Phone:317-518-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty