Healthcare Provider Details

I. General information

NPI: 1679915649
Provider Name (Legal Business Name): CALICO HILLS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 US HWY 95N
SCHURZ NV
89427-0426
US

IV. Provider business mailing address

PO BOX 426
SCHURZ NV
89427-0426
US

V. Phone/Fax

Practice location:
  • Phone: 775-945-2298
  • Fax: 775-945-2262
Mailing address:
  • Phone: 775-945-2298
  • Fax: 775-945-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0632
License Number StateNV

VIII. Authorized Official

Name: MRS. TERESA L EMM-REEDY
Title or Position: SOLE MEMBER
Credential: PT
Phone: 775-945-2298