Provider Demographics
NPI:1306123062
Name:HORTON, JESSE THOMAS (DPT)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:THOMAS
Last Name:HORTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2140 KINGSLEY AVENUE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-272-2830
Mailing Address - Fax:904-215-3970
Practice Address - Street 1:1835 EAST WEST PARKWAY
Practice Address - Street 2:SUITE 16
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003
Practice Address - Country:US
Practice Address - Phone:904-215-3958
Practice Address - Fax:904-215-3970
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT26845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist