MEDICARE: BRIENNA HORINE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2016042110	MO

General Provider Information

NPI Number	:	1417490913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIENNA HORINE DPT

Provider Business Mailing Address
First Line	:	4021 BARLOW ST
Second Line	:
City	:	COTTLEVILLE
State	:	MO
Zip	:	63376-3050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3758 MONTICELLO PLZ
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-8613
Country	:	US
Telephone Number	:	636-329-0110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	12/01/2016

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