Individual
LARISSA L. HORNER
Active
Individual
LARISSA L. HORNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
006815
WV
225100000X
Physical Therapist
Primary
068615
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000204524
OH MEDICAID UNISON
OH
01
—
000000217253
ANTHEM BCBS
—
05
—
0157960000
—
WV
01
—
2221287
MOLINA MEDICAID
OH
05
—
2221287
—
OH
01
—
650019667
RR MEDICARE
—
Enumeration date
07/19/2006
Last updated
10/07/2010
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