Provider Demographics
NPI:1205317526
Name:VAN HORN, WILLIAM CARL JR
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CARL
Last Name:VAN HORN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E FM 1187
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4349
Mailing Address - Country:US
Mailing Address - Phone:817-297-5600
Mailing Address - Fax:
Practice Address - Street 1:920 E FM 1187
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4349
Practice Address - Country:US
Practice Address - Phone:817-297-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2030583225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant