Provider Demographics
NPI:1740649136
Name:HORACE, REONDRA
Entity type:Individual
Prefix:
First Name:REONDRA
Middle Name:
Last Name:HORACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REONDRA
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-340-9708
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:5291 VALLEYDALE RD
Practice Address - Street 2:SUITE 113
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-7705
Practice Address - Country:US
Practice Address - Phone:205-408-4123
Practice Address - Fax:205-408-4189
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529917620Medicaid
AL1003819608OtherGROUP NPI
AL1003819608OtherGROUP NPI