Healthcare Provider Details

I. General information

NPI: 1285615872
Provider Name (Legal Business Name): MICHAEL T HORAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 TURKEY CRK
ALACHUA FL
32615-9500
US

IV. Provider business mailing address

44 TURKEY CRK
ALACHUA FL
32615-9500
US

V. Phone/Fax

Practice location:
  • Phone: 386-312-0022
  • Fax: 386-312-0535
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA16180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: