1396170072 NPI number — JESSICA ANN HORN ATC

Table of content: JESSICA ANN HORN ATC (NPI 1396170072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396170072 NPI number — JESSICA ANN HORN ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORN
Provider First Name:
JESSICA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396170072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20410 CENTURY BLVD
Provider Second Line Business Mailing Address:
MEDSTAR NRH REHAB NETWORK - #215
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20874-1186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-540-6140
Provider Business Mailing Address Fax Number:
301-540-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20410 CENTURY BLVD
Provider Second Line Business Practice Location Address:
MEDSTAR NRH REHAB NETWORK - #215
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20874-1186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-540-6140
Provider Business Practice Location Address Fax Number:
301-540-5190
Provider Enumeration Date:
09/12/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  A0000528 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)