1447025432 NPI number — HORTON'S ORTHOTIC LAB, INC.

Table of content: (NPI 1447025432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447025432 NPI number — HORTON'S ORTHOTIC LAB, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORTON'S ORTHOTIC LAB, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447025432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 W COMMERCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYANT
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72022-7510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-847-6999
Provider Business Mailing Address Fax Number:
501-847-6999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2760 BROWNS LN STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-7271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-641-0444
Provider Business Practice Location Address Fax Number:
870-641-0777
Provider Enumeration Date:
11/20/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HORTON
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
501-847-6999

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)