Provider Demographics
NPI:1306692777
Name:HORNSBY, MARIAH (LMT)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-1647
Mailing Address - Country:US
Mailing Address - Phone:860-835-4839
Mailing Address - Fax:
Practice Address - Street 1:521 DAVIS RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-1647
Practice Address - Country:US
Practice Address - Phone:860-835-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9775225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist