Provider Demographics
NPI:1598772121
Name:HORN, LAURA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:HORN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:CORIGLIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5207 LOLETA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1503
Mailing Address - Country:US
Mailing Address - Phone:323-314-3415
Mailing Address - Fax:323-982-9018
Practice Address - Street 1:1158 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1403
Practice Address - Country:US
Practice Address - Phone:323-314-3415
Practice Address - Fax:323-982-9018
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ66936Medicare ID - Type Unspecified