Provider Demographics
NPI:1316621022
Name:HORTON, AUSTIN RANDOLPH (PTA)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:RANDOLPH
Last Name:HORTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 CARROLLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-3891
Mailing Address - Country:US
Mailing Address - Phone:276-730-5146
Mailing Address - Fax:
Practice Address - Street 1:1113 CARROLLTON PIKE
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-3891
Practice Address - Country:US
Practice Address - Phone:276-728-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306606029225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant