Healthcare Provider Details

I. General information

NPI: 1518980234
Provider Name (Legal Business Name): BRENDA HORN M.H.S. /P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 W KANSAS AVE
CHICKASHA OK
73018-3322
US

IV. Provider business mailing address

3666 STATE HIGHWAY 92
CHICKASHA OK
73018-7014
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-5030
  • Fax: 405-222-5050
Mailing address:
  • Phone: 405-222-5030
  • Fax: 405-222-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 464
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT 464
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 464
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 464
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: