Provider Demographics
NPI:1326193517
Name:HORTZ, BRIAN VINCENT (PHD, ATC)
Entity Type:Individual
Prefix:PROF
First Name:BRIAN
Middle Name:VINCENT
Last Name:HORTZ
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:VINCENT
Other - Last Name:HORTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:924 LOCKMEAD CT
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7364
Mailing Address - Country:US
Mailing Address - Phone:614-866-1740
Mailing Address - Fax:
Practice Address - Street 1:200 LIVINGSTON DR.
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023
Practice Address - Country:US
Practice Address - Phone:740-587-6577
Practice Address - Fax:740-587-5742
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-0009672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer