1699817908 NPI number — NEW HORIZONS PHYSICAL THERAPY, PC

Table of content: (NPI 1699817908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699817908 NPI number — NEW HORIZONS PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HORIZONS PHYSICAL THERAPY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW HORIZONS PHYSICAL THERAPY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699817908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
169 SAXONY RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-6778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-230-6472
Provider Business Mailing Address Fax Number:
760-230-6473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
169 SAXONY RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-6778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-230-6472
Provider Business Practice Location Address Fax Number:
760-230-6473
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONDRY
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
DOCTOR OF PHYSICAL THERAPY,CO-OWNER
Authorized Official Telephone Number:
858-764-2409

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT20026 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0PT200260 . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5306540001 . This is a "MEDICARE DME SOUTHERN CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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