Healthcare Provider Details

I. General information

NPI: 1013384007
Provider Name (Legal Business Name): TARA HORTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 AYERS LN
LITTLE SILVER NJ
07739-1201
US

IV. Provider business mailing address

621 PARK AVE
BRIELLE NJ
08730-1809
US

V. Phone/Fax

Practice location:
  • Phone: 732-530-1661
  • Fax:
Mailing address:
  • Phone: 732-547-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA01856000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: