Provider Demographics
NPI:1306221643
Name:HORNE, JOHN MACKAY (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MACKAY
Last Name:HORNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4094 4TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2143
Mailing Address - Country:US
Mailing Address - Phone:619-849-4470
Mailing Address - Fax:
Practice Address - Street 1:4094 4TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2143
Practice Address - Country:US
Practice Address - Phone:619-849-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist