Provider Demographics
NPI:1457542599
Name:KIMBERLY HORN
Entity type:Organization
Organization Name:KIMBERLY HORN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OTR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:940-357-1266
Mailing Address - Street 1:4301 COLLEGE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3128
Mailing Address - Country:US
Mailing Address - Phone:940-357-1266
Mailing Address - Fax:940-553-1602
Practice Address - Street 1:4301 COLLEGE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3128
Practice Address - Country:US
Practice Address - Phone:940-357-1266
Practice Address - Fax:940-553-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109025261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy