Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 9909A | AZ |
NPI | 1013265461 |
---|---|
Provider Name | Mr. Scott Horton |
First Address | Lake Havasu City, AZ 86403-5648 |
Second Address | Lake Havasu City, AZ 86403-5648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2012 |
Last Update Date | 16/08/2012 |