Provider Demographics
NPI:1265483754
Name:HORNE, CONNIE SUE (MPT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:HORNE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 S 56TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3392
Mailing Address - Country:US
Mailing Address - Phone:402-420-0800
Mailing Address - Fax:402-420-0801
Practice Address - Street 1:6101 S 56TH ST
Practice Address - Street 2:STE 1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3392
Practice Address - Country:US
Practice Address - Phone:402-420-0800
Practice Address - Fax:402-420-0801
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09157OtherBLUE CROSS BLUE SHIELD
NE650023329Medicare PIN
NE09157OtherBLUE CROSS BLUE SHIELD