Healthcare Provider Details

I. General information

NPI: 1629033121
Provider Name (Legal Business Name): NEW HORIZONS PHYSICAL THERAPY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S WHITE MOUNTAIN RD SUITE A
SHOW LOW AZ
85901-7876
US

IV. Provider business mailing address

4800 S WHITE MOUNTAIN RD SUITE A
SHOW LOW AZ
85901-7876
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-8766
  • Fax: 928-537-8786
Mailing address:
  • Phone: 928-537-8766
  • Fax: 928-537-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2451
License Number StateAZ

VIII. Authorized Official

Name: MRS. TAMORA VAN DRIEL
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 928-537-8766