Provider Demographics
NPI:1639568561
Name:HORNSBY, TERI (LMT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SPEED HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9741
Mailing Address - Country:US
Mailing Address - Phone:585-880-6112
Mailing Address - Fax:607-319-4012
Practice Address - Street 1:103 SHARLENE RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-6315
Practice Address - Country:US
Practice Address - Phone:607-277-1468
Practice Address - Fax:607-319-4012
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024444-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist