Provider Demographics
NPI:1679903264
Name:HORNE, JUSTIN E (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:E
Last Name:HORNE
Suffix:
Gender:M
Credentials:DPT
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 5545
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-5545
Mailing Address - Country:US
Mailing Address - Phone:803-441-0025
Mailing Address - Fax:803-441-0031
Practice Address - Street 1:4039 GATEWAY BLVD
Practice Address - Street 2:STE 102
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3195
Practice Address - Country:US
Practice Address - Phone:706-210-9534
Practice Address - Fax:706-210-9536
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist