Provider Demographics
NPI:1063589844
Name:HORNER, ELAINE MARGARET (PT)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARGARET
Last Name:HORNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NORTH ROOSEVELT STREET
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401
Mailing Address - Country:US
Mailing Address - Phone:605-725-9900
Mailing Address - Fax:605-725-9902
Practice Address - Street 1:6 NORTH ROOSEVELT STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-725-9900
Practice Address - Fax:605-725-9902
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD100408Medicaid
PT0532OtherDAKOTACARE
4994602OtherBCBS
SD100408Medicaid