Healthcare Provider Details

I. General information

NPI: 1306129747
Provider Name (Legal Business Name): HORTONS ORTHOTIC LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W COMMERCE DR
BRYANT AR
72022-7510
US

IV. Provider business mailing address

5220 W 12TH ST
LITTLE ROCK AR
72204-1857
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-2908
  • Fax: 501-663-3994
Mailing address:
  • Phone: 501-663-2908
  • Fax: 501-663-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY HORTON
Title or Position: OWNER
Credential: CO
Phone: 501-663-2908