Individual
JACIE E HORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
14 E AYERS ST, EDMOND, OK 73034-3667
(405) 513-8186
Mailing address
14 E AYERS ST, EDMOND, OK 73034-3667
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4135
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200584160A
—
OK
Enumeration date
08/31/2015
Last updated
09/04/2015
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