Provider Demographics
NPI:1497859656
Name:HORNE, TRACY M (PT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:HORNE
Suffix:
Gender:F
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:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-0764
Mailing Address - Country:US
Mailing Address - Phone:802-388-3533
Mailing Address - Fax:802-388-2334
Practice Address - Street 1:115 PORTER DR
Practice Address - Street 2:PORTER HOSPITAL
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-4777
Practice Address - Fax:802-388-8877
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008069Medicaid
VT1008069Medicaid