Provider Demographics
NPI:1295761179
Name:HORNER, MANDY S (MED, ATC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:S
Last Name:HORNER
Suffix:
Gender:F
Credentials:MED, ATC
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 404
Mailing Address - Street 2:
Mailing Address - City:MILLHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:16854-0404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 PENN ST
Practice Address - Street 2:
Practice Address - City:MILLHEIM
Practice Address - State:PA
Practice Address - Zip Code:16854
Practice Address - Country:US
Practice Address - Phone:814-422-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0031222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer