Provider Demographics
NPI:1043409436
Name:HORTON, ROGER L (LICENSED PHYSICAL TH)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:HORTON
Suffix:
Gender:M
Credentials:LICENSED PHYSICAL TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1113 CARROLLTON PIKE
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343
Mailing Address - Country:US
Mailing Address - Phone:276-728-0700
Mailing Address - Fax:276-728-0755
Practice Address - Street 1:1113 CARROLLTON PIKE
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343
Practice Address - Country:US
Practice Address - Phone:276-728-0700
Practice Address - Fax:276-728-0755
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2306000885225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant