Active NPI
Michael Glenn Hornbuckle, PTA, ATC
- Physical Therapy Assistant
- Dyer, IN
National Provider Identifier
1922093418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06006874A
- Practice address
- 1427 Joliet St Unit C
Dyer, IN 46311-2026 - Phone
- (219) 319-0110
- NPI assigned
- Sep 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.010184 | IL | |
| Athletic Trainer | 2255A2300X | 36001065A | IN | |
| Physical Therapy Assistant | 225200000X | 06006874A | IN | Primary |
Addresses
Primary practice location
1427 Joliet St Unit C
Dyer, IN 46311-2026
Mailing address
9145 W 103Rd St
Saint John, IN 46373-8794
Phone (219) 319-0110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.010184 | IL | MD | Physical Therapy Assistant |
| 06006874A | IN | MD | Physical Therapy Assistant |
| 36001065A | IN | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trademark Performance Corporation | Athletic Trainer | Current | Accepting new patients |
| Trademark Performance Corporation | Athletic Trainer | Current | Accepting new patients |
| Flexeon Rehabilitation of Munster, LLC | Past | Accepting new patients |
Locations
1427 Lincoln Hwy
Ste C
Dyer, IN 46311
Phone (219) 319-0110
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Munster, IN
- NPI 1700838331
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1922093418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9145 W 103RD ST",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463738794",
"telephone_number": "219-319-0110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1427 JOLIET ST UNIT C",
"city": "DYER",
"state": "IN",
"postal_code": "463112026",
"telephone_number": "219-319-0110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HORNBUCKLE",
"first_name": "MICHAEL",
"middle_name": "GLENN",
"name_prefix": "Mr.",
"credential": "PTA, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-12",
"last_updated": "2024-08-22",
"certification_date": "2024-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.010184",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36001065A",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06006874A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dyer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.