=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609021989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HORIZONE PHYSICAL THERAPY AND REHABILITATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2008
-----------------------------------------------------
Last Update Date | 12/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4161 TAMIAMI TRL SUITE 304A
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-9204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-258-3510
-----------------------------------------------------
Fax | 941-258-3512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4161 TAMIAMI TRL SUITE 304A
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-9204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-258-3510
-----------------------------------------------------
Fax | 941-258-3512
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. JULITA E LATHERS
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 941-258-3510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------