Provider Demographics
NPI:1821019993
Name:HORN, KELLI HARBINSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:HARBINSON
Last Name:HORN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 SEACROFT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-2950
Mailing Address - Country:US
Mailing Address - Phone:704-877-0914
Mailing Address - Fax:
Practice Address - Street 1:5727 PROSPERITY CROSSING DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2206
Practice Address - Country:US
Practice Address - Phone:704-863-9970
Practice Address - Fax:704-863-9971
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2500832Medicare UPIN