Provider Demographics
NPI:1073850301
Name:HORNE, WESTON J (LMT)
Entity Type:Individual
Prefix:
First Name:WESTON
Middle Name:J
Last Name:HORNE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E 100 S
Mailing Address - Street 2:#204
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1740
Mailing Address - Country:US
Mailing Address - Phone:801-856-6950
Mailing Address - Fax:
Practice Address - Street 1:2760 SOUTH 1174 EAST
Practice Address - Street 2:SUITE 1D
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109
Practice Address - Country:US
Practice Address - Phone:801-856-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7501150-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist