Provider Demographics
NPI:1306129747
Name:HORTONS ORTHOTIC LAB INC
Entity type:Organization
Organization Name:HORTONS ORTHOTIC LAB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:501-663-2908
Mailing Address - Street 1:5220 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1857
Mailing Address - Country:US
Mailing Address - Phone:501-663-2908
Mailing Address - Fax:501-663-3994
Practice Address - Street 1:605 W COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7510
Practice Address - Country:US
Practice Address - Phone:501-663-2908
Practice Address - Fax:501-663-3994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORTONS ORTHOTIC LAB INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-22
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier