Provider Demographics
NPI:1447025432
Name:HORTON'S ORTHOTIC LAB, INC.
Entity type:Organization
Organization Name:HORTON'S ORTHOTIC LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-847-6999
Mailing Address - Street 1:605 W COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7510
Mailing Address - Country:US
Mailing Address - Phone:501-847-6999
Mailing Address - Fax:501-847-6999
Practice Address - Street 1:2760 BROWNS LN STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7271
Practice Address - Country:US
Practice Address - Phone:870-641-0444
Practice Address - Fax:870-641-0777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORTON'S ORTHOTIC LAB, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier