Individual
MATTHEW HORNBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT, LMT
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
62408
OR
225700000X
Massage Therapist
16338
OR
Other
Enumeration date
10/29/2009
Last updated
07/21/2022
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