Provider Demographics
NPI:1063509032
Name:HORTON, JAYME L (PT, DHS, PCS)
Entity type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:L
Last Name:HORTON
Suffix:
Gender:F
Credentials:PT, DHS, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W HOLLAND RD E
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9641
Mailing Address - Country:US
Mailing Address - Phone:812-631-1980
Mailing Address - Fax:
Practice Address - Street 1:671 3RD AVE STE 2
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3652
Practice Address - Country:US
Practice Address - Phone:812-631-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007331A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200736260AMedicaid