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General NPI Number Information
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NPI Number | 1750893020
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Entity Type | Individual
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Provider Name | ARTHUR HORNE ATC
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Gender | Male
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 840 WINTER ST
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City | WALTHAM
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State | MA
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Zip | 02451-1433
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Country | US
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Telephone | 781-522-2624
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Fax |
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Provider Business Mailing Address
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Address Line | 240 WESTMINSTER AVE
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City | WATERTOWN
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State | MA
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Zip | 02472-1166
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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 | 1396
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License Number State | MA
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