Provider Demographics
NPI:1871569764
Name:HIGH DESERT THERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:HIGH DESERT THERAPY ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-593-8535
Mailing Address - Street 1:PO BOX 4185
Mailing Address - Street 2:
Mailing Address - City:SUNRIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97707
Mailing Address - Country:US
Mailing Address - Phone:541-593-8535
Mailing Address - Fax:541-593-0316
Practice Address - Street 1:56881 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:SUNRIVER
Practice Address - State:OR
Practice Address - Zip Code:97707
Practice Address - Country:US
Practice Address - Phone:541-593-8535
Practice Address - Fax:541-593-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCXBRMedicare PIN