Provider Demographics
NPI:1972920122
Name:HORIZONS PEDIATRIC THERAPY PLLC
Entity type:Organization
Organization Name:HORIZONS PEDIATRIC THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TROTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:512-884-0175
Mailing Address - Street 1:109 CARLINA LOOP
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-0025
Mailing Address - Country:US
Mailing Address - Phone:512-884-0175
Mailing Address - Fax:
Practice Address - Street 1:109 CARLINA LOOP
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-0025
Practice Address - Country:US
Practice Address - Phone:346-531-9448
Practice Address - Fax:512-988-5459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110687261QH0700X
261QD1600X, 261QA3000X, 171W00000X, 1744G0900X, 174H00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative CommunicationGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No1744G0900XOther Service ProvidersSpecialistGraphics DesignerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
13562404OtherCAQH
TX09894354OtherSTATE OF TEXAS DRIVERS LICENSE
1780824680OtherINDIVIDUAL NPI NUMBER
TX1Z0625Medicaid
14101180OtherASHA CERTIFICATION NUMBER
TX110687OtherSTATE OF TEXAS SLP LICENSE
AZ14056OtherSTATE OF ARIZONA SLP LICENSE