Provider Demographics
NPI:1689615106
Name:HORSLEY, JOHN R (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:HORSLEY
Suffix:
Gender:M
Credentials:PT
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 8125
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8125
Mailing Address - Country:US
Mailing Address - Phone:714-638-8693
Mailing Address - Fax:714-638-3940
Practice Address - Street 1:1235 PEAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1444
Practice Address - Country:US
Practice Address - Phone:714-638-8693
Practice Address - Fax:714-638-3940
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16520204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT16520AMedicare ID - Type Unspecified