Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 464 | OK |
N | 2251N0400X | Physical Therapist - Neurology | PT 464 | OK |
N | 2251P0200X | Physical Therapist - Pediatrics | PT 464 | OK |
N | 2251X0800X | Physical Therapist - Orthopedic | PT 464 | OK |
NPI | 1518980234 |
---|---|
Provider Name | Brenda Horn |
First Address | Chickasha, OK 73018-7014 |
Second Address | Chickasha, OK 73018-3322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 31/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201994098001 | BLUE CROSS BLUE SHIELDS (01) | |
PT 464 | PHYSICAL THER. LIC. # (01) | OK |
R11489 | (02) | OK |