Provider Demographics
NPI:1518980234
Name:HORN, BRENDA (MHS /PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:MHS /PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3666 STATE HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-7014
Mailing Address - Country:US
Mailing Address - Phone:405-222-5030
Mailing Address - Fax:405-222-5050
Practice Address - Street 1:626 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-3322
Practice Address - Country:US
Practice Address - Phone:405-222-5030
Practice Address - Fax:405-222-5050
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT 464225100000X, 2251N0400X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
201994098001OtherBLUE CROSS BLUE SHIELDS
OKPT 464OtherPHYSICAL THER. LIC. #
201994098001OtherBLUE CROSS BLUE SHIELDS