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General NPI Number Information
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NPI Number | 1326475831
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Entity Type | Individual
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Provider Name | MICHELLE HORNE ATC
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Gender | Female
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Dates
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Enumeration Date | 09/28/2013
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 1551 RENAISSANCE TOWNE DR SUITE 420
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City | BOUNTIFUL
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State | UT
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Zip | 84010-7667
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Country | US
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Telephone | 801-694-9791
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Fax |
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Provider Business Mailing Address
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Address Line | 309 E 100 S APT 424
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-1740
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 8716708-4810
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License Number State | UT
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