Healthcare Provider Details

I. General information

NPI: 1447252879
Provider Name (Legal Business Name): TELEATHEA HORNE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 VILLAGE DR
FAYETTEVILLE NC
28304-3815
US

IV. Provider business mailing address

2930 VILLAGE DR
FAYETTEVILLE NC
28304-3815
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-9010
  • Fax: 910-323-9568
Mailing address:
  • Phone: 910-323-9010
  • Fax: 910-323-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2845
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: