Provider Demographics
NPI:1548512890
Name:STRONGHOLD EQUINE ASSISTED THERAPY
Entity type:Organization
Organization Name:STRONGHOLD EQUINE ASSISTED THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:520-730-5401
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:PEARCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85625-0314
Mailing Address - Country:US
Mailing Address - Phone:520-730-5401
Mailing Address - Fax:
Practice Address - Street 1:3661 E ANTELOPE RD
Practice Address - Street 2:
Practice Address - City:PEARCE
Practice Address - State:AZ
Practice Address - Zip Code:85625-6214
Practice Address - Country:US
Practice Address - Phone:520-730-5401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0019261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation