Provider Demographics
NPI:1588961155
Name:THURMAN HORNBUCKLE III
Entity type:Organization
Organization Name:THURMAN HORNBUCKLE III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:MR
Authorized Official - First Name:THURMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNBUCKLE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:310-292-2844
Mailing Address - Street 1:517 N 2870 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-8259
Mailing Address - Country:US
Mailing Address - Phone:310-292-2844
Mailing Address - Fax:
Practice Address - Street 1:517 N 2870 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-8259
Practice Address - Country:US
Practice Address - Phone:310-292-2844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty