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Individual
STACY JLYN HORNER
Active
Individual
STACY JLYN HORNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTL.0004987
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12017600
—
WY
05
—
75255545
—
CO
01
—
P00374924
RR MEDICARE
CO
Enumeration date
11/22/2005
Last updated
12/16/2019
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