Provider Demographics
NPI:1407264310
Name:HORSLEY, JOHN GILBERT (MED, ATC, LAT, CSCS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GILBERT
Last Name:HORSLEY
Suffix:
Gender:M
Credentials:MED, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 MELLOW MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1824
Mailing Address - Country:US
Mailing Address - Phone:512-464-4053
Mailing Address - Fax:512-464-4030
Practice Address - Street 1:12400 MELLOW MEADOW DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1824
Practice Address - Country:US
Practice Address - Phone:512-464-4053
Practice Address - Fax:512-464-4030
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT37072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer