Provider Demographics
NPI:1124389218
Name:LAURA HORN PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:LAURA HORN PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:323-314-3415
Mailing Address - Street 1:5207 LOLETA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1503
Mailing Address - Country:US
Mailing Address - Phone:323-314-3415
Mailing Address - Fax:323-982-9018
Practice Address - Street 1:1158 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1403
Practice Address - Country:US
Practice Address - Phone:323-314-3415
Practice Address - Fax:323-982-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty