Provider Demographics
NPI:1124544663
Name:HORNER, LAURA ALESSANDRA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ALESSANDRA
Last Name:HORNER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1754
Mailing Address - Country:US
Mailing Address - Phone:405-255-2759
Mailing Address - Fax:
Practice Address - Street 1:325 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1769
Practice Address - Country:US
Practice Address - Phone:731-352-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer