Provider Demographics
NPI:1497009237
Name:HORTON, JEWEL KRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:KRISTINE
Last Name:HORTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 ALLIANCE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8836
Mailing Address - Country:US
Mailing Address - Phone:317-821-3740
Mailing Address - Fax:317-821-3750
Practice Address - Street 1:10701 ALLIANCE DR
Practice Address - Street 2:SUITE D
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8836
Practice Address - Country:US
Practice Address - Phone:317-821-3740
Practice Address - Fax:317-821-3750
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11948225100000X
IN05011727A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist