Provider Demographics
NPI:1396959748
Name:HORNE, VANESSA M (PT, ATC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:HORNE
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:M
Other - Last Name:GILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:1855 TANNER WAY STE 140
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8331
Practice Address - Country:US
Practice Address - Phone:865-376-6566
Practice Address - Fax:865-376-6806
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN08492255A2300X
TN0000007471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ030402Medicaid