Healthcare Provider Details

I. General information

NPI: 1043151723
Provider Name (Legal Business Name): REGINIA HORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 CONCORD MILLS BLVD STE 671A
CONCORD NC
28027-4400
US

IV. Provider business mailing address

10310 OLDE IVY WAY
CHARLOTTE NC
28262-2555
US

V. Phone/Fax

Practice location:
  • Phone: 704-930-3771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: