Healthcare Provider Details

I. General information

NPI: 1477089860
Provider Name (Legal Business Name): NANCY SUSAN HORNBUCKLE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 COLLEGE AVE
NEW HOPE AL
35760-9035
US

IV. Provider business mailing address

382 COLLEGE AVE
NEW HOPE AL
35760-9035
US

V. Phone/Fax

Practice location:
  • Phone: 251-424-4486
  • Fax:
Mailing address:
  • Phone: 251-424-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2203
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: