Provider Demographics
NPI:1285766246
Name:NEW HEIGHTS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:NEW HEIGHTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-426-4870
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-0355
Mailing Address - Country:US
Mailing Address - Phone:541-432-1480
Mailing Address - Fax:541-432-1481
Practice Address - Street 1:4 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:JOSEPH
Practice Address - State:OR
Practice Address - Zip Code:97846-8434
Practice Address - Country:US
Practice Address - Phone:541-432-1480
Practice Address - Fax:541-432-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278254Medicaid
OR278254Medicaid