Provider Demographics
NPI:1134669138
Name:HORTONS ORTHOTIC LAB, INC.
Entity Type:Organization
Organization Name:HORTONS ORTHOTIC LAB, INC.
Other - Org Name:HORTONS ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:LO, CO
Authorized Official - Phone:501-663-2908
Mailing Address - Street 1:5220 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1857
Mailing Address - Country:US
Mailing Address - Phone:501-663-2908
Mailing Address - Fax:501-663-3994
Practice Address - Street 1:635 DAVE WARD
Practice Address - Street 2:SUITE 103
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-663-2908
Practice Address - Fax:501-663-3994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORTONS ORTHOTIC LAB, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00087335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier