Provider Demographics
NPI:1265787527
Name:HORN BRANSON, DELISA RENE' (LPTA)
Entity type:Individual
Prefix:
First Name:DELISA
Middle Name:RENE'
Last Name:HORN BRANSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:DELISA
Other - Middle Name:RENE'
Other - Last Name:BRANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPTA
Mailing Address - Street 1:632 HURT ST SW
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3018
Mailing Address - Country:US
Mailing Address - Phone:423-213-7318
Mailing Address - Fax:
Practice Address - Street 1:632 HURT ST SW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3018
Practice Address - Country:US
Practice Address - Phone:423-213-7318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001094225200000X
TN0000004417225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant