Provider Demographics
NPI:1972819837
Name:HORNE, STACY ELLEN (MS, PT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ELLEN
Last Name:HORNE
Suffix:
Gender:F
Credentials:MS, 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 526
Mailing Address - Street 2:66 LAKE NATALIE DRIVE
Mailing Address - City:GOULDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18424-0526
Mailing Address - Country:US
Mailing Address - Phone:570-309-8070
Mailing Address - Fax:570-842-0551
Practice Address - Street 1:66 LAKE NATALIE DR
Practice Address - Street 2:
Practice Address - City:GOULDSBORO
Practice Address - State:PA
Practice Address - Zip Code:18424-8846
Practice Address - Country:US
Practice Address - Phone:570-309-8070
Practice Address - Fax:570-842-0551
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist