Provider Demographics
NPI:1972920122
Name:HORIZONS PEDIATRIC THERAPY PLLC
Entity type:Organization
Organization Name:HORIZONS PEDIATRIC THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TROTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:512-884-0175
Mailing Address - Street 1:109 CARLINA LOOP
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-0025
Mailing Address - Country:US
Mailing Address - Phone:512-884-0175
Mailing Address - Fax:
Practice Address - Street 1:109 CARLINA LOOP
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-0025
Practice Address - Country:US
Practice Address - Phone:346-531-9448
Practice Address - Fax:512-988-5459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 1744G0900X, 174H00000X, 261Q00000X, 261QA3000X, 261QD1600X
TX110687261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No1744G0900XOther Service ProvidersSpecialistGraphics DesignerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative CommunicationGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
13562404OtherCAQH
TX09894354OtherSTATE OF TEXAS DRIVERS LICENSE
1780824680OtherINDIVIDUAL NPI NUMBER
TX1Z0625Medicaid
14101180OtherASHA CERTIFICATION NUMBER
TX110687OtherSTATE OF TEXAS SLP LICENSE
AZ14056OtherSTATE OF ARIZONA SLP LICENSE