Provider Demographics
NPI:1992733646
Name:HORNER, JESSICA THERIOT (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:THERIOT
Last Name:HORNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CHENEVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8080 BLUEBONNET BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-924-2424
Mailing Address - Fax:225-408-7980
Practice Address - Street 1:400 W ST FRANCIS ST STE 1
Practice Address - Street 2:
Practice Address - City:BRUSLY
Practice Address - State:LA
Practice Address - Zip Code:70719-2283
Practice Address - Country:US
Practice Address - Phone:225-960-2680
Practice Address - Fax:225-256-0208
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H905C610Medicare PIN