Healthcare Provider Details

I. General information

NPI: 1629063607
Provider Name (Legal Business Name): HORTONS ORTHOTIC LAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 MARION ST SUITE 304
SEARCY AR
72143-4878
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 501-268-2272
  • Fax: 501-268-2994
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: CEO
Credential:
Phone: 501-663-2908