Provider Demographics
NPI:1831403393
Name:HORNE, SARAH VIRGINIA (MPT)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:VIRGINIA
Last Name:HORNE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:VIRGINIA
Other - Last Name:WINANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:222 SEQUOYAH RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-5154
Practice Address - Country:US
Practice Address - Phone:423-332-3601
Practice Address - Fax:423-332-3602
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011366225100000X
TN10217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01459314OtherRR MEDICARE
TNP01459314OtherRR MEDICARE
MIN69750011Medicare PIN