Provider Demographics
NPI:1043268444
Name:HORNE, MATTHEW W (PT CSCS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:HORNE
Suffix:
Gender:M
Credentials:PT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-3533
Mailing Address - Fax:802-388-2334
Practice Address - Street 1:175 WILSON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-3533
Practice Address - Fax:802-388-2334
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT58232OtherBCBSHIELD GRP #
VT363321OtherMVP GRP #
VT58232OtherBCBSHIELD GRP #