Healthcare Provider Details

I. General information

NPI: 1710061460
Provider Name (Legal Business Name): BYRON H HORNER M.S.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 WEST STATE ROAD 248 SUITE A
KAMAS UT
84036-9595
US

IV. Provider business mailing address

PO BOX 13
HEBER CITY UT
84032-0013
US

V. Phone/Fax

Practice location:
  • Phone: 435-783-2659
  • Fax: 435-783-2660
Mailing address:
  • Phone: 435-654-0804
  • Fax: 435-654-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4819784-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4819784-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: