Provider Demographics
NPI:1679915649
Name:CALICO HILLS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:CALICO HILLS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMM-REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:775-945-2298
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:SCHURZ
Mailing Address - State:NV
Mailing Address - Zip Code:89427-0426
Mailing Address - Country:US
Mailing Address - Phone:775-945-2298
Mailing Address - Fax:775-945-2262
Practice Address - Street 1:4021 US HWY 95N
Practice Address - Street 2:
Practice Address - City:SCHURZ
Practice Address - State:NV
Practice Address - Zip Code:89427-0426
Practice Address - Country:US
Practice Address - Phone:775-945-2298
Practice Address - Fax:775-945-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295756971OtherINDIVIDUAL NPI
NV00431101Medicaid
V106547Medicare PIN
NV00431101Medicaid