Colorado River Physical Therapy LLC
Organization Active NPI Physical Therapist · Fort Mohave, AZ
NPI 1245965342 · NPPES record last updated Sep 29, 2023
Key facts
- NPI
- 1245965342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- COLORADO RIVER PHYSICAL THERAPY LLC
- Practice address
- 1510 E Wagon Wheel LN
Fort Mohave, AZ 86426-6697 - Phone
- (928) 788-3333
- Fax
- (928) 788-3555
- NPI assigned
- Jul 21, 2022
- Organization subpart
- No
Authorized official
- Name
- Hanz Tabora, PT,DPT
- Title
- Physical Therapist/ Officer
- Phone
- (928) 248-0444
Practitioners 2
-
Rhenand Mendoza, PT, DPT
-
Hanz K Tabora, P.T., DPT, FAAOMPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ, CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230421002264 | AZ | Part B Supplier - Clinic/Group Practice | 1254796469 |
Receives reassigned benefits from 2 practitioners Practice locations: Lake Havasu City, AZ; Fort Mohave, AZ |
| O20240513000453 | CA | Part B Supplier - Clinic/Group Practice | 1254796469 |
Receives reassigned benefits from 1 practitioner Practice locations: Needles, CA |
National Provider Directory
Locations
1510 E Wagon Wheel Ln
Ste 110
Fort Mohave, AZ 86426
Phone (904) 994-5560
1510 E Wagon Wheel Ln
Ste 102
Fort Mohave, AZ 86426
Phone (904) 994-5560
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Physical Therapy Clinic/Center | 261QP2000X |
Addresses
Primary practice location
1510 E Wagon Wheel LN
Fort Mohave, AZ 86426-6697
Mailing address
1510 E Wagon Wheel LN Ste 110
Fort Mohave, AZ 86426-6698
Phone (928) 248-0444
Other practice location 1
1987 McCulloch Blvd N Ste 101
Lake Havasu City, AZ 86403-5770
Phone (928) 788-3333
Other names
- Tri State Physical Therapy
Other providers in Fort Mohave, AZ
- CL Valley Dental
- Clarity Mental Health Counselling, PLLC
- Mark Alan Collins
- Qun Collins
- Colorado River Pediatrics, LLC
- Colorado River Primary Care, Inc
- Vicky Renee Conder-Elliott
- Copper State Medical Center
- Terry L Coyle
- Corinne N Depriest
All providers in Fort Mohave, AZ · Physical Therapist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.