Individual
MR. MICHAEL GLENN HORNBUCKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA, ATC
Contact information
Practice address
1427 JOLIET ST UNIT C, DYER, IN 46311-2026
(219) 319-0110
Mailing address
9145 W 103RD ST, SAINT JOHN, IN 46373-8794
(219) 319-0110
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06006874A
IN
225200000X
Physical Therapy Assistant
160.010184
IL
2255A2300X
Athletic Trainer
36001065A
IN
Other
Enumeration date
09/12/2005
Last updated
08/22/2024
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