Provider Demographics
NPI:1023391018
Name:HORNER, NATALIE JEANNE (PTA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JEANNE
Last Name:HORNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 KIMBLE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-7151
Mailing Address - Country:US
Mailing Address - Phone:317-373-8066
Mailing Address - Fax:
Practice Address - Street 1:2355 NORTHSIDE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2705
Practice Address - Country:US
Practice Address - Phone:800-458-7777
Practice Address - Fax:800-863-2978
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003122A171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor