Provider Demographics
NPI:1457520959
Name:HORN, DEBRA J (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:HORN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:609 FARMINGTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3081
Mailing Address - Country:US
Mailing Address - Phone:860-241-1144
Mailing Address - Fax:860-241-1188
Practice Address - Street 1:100 WELLS ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2920
Practice Address - Country:US
Practice Address - Phone:860-241-1144
Practice Address - Fax:860-241-1188
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT005575225100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650000872Medicare PIN