Provider Demographics
NPI:1568234847
Name:HORN, KAILYN RUTH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:RUTH
Last Name:HORN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3304
Mailing Address - Country:US
Mailing Address - Phone:803-973-0100
Mailing Address - Fax:803-973-0117
Practice Address - Street 1:10216 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9679
Practice Address - Country:US
Practice Address - Phone:803-973-1717
Practice Address - Fax:803-462-5804
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist