Provider Demographics
NPI:1043294937
Name:THIO, BRIAN (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:THIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-0870
Mailing Address - Country:US
Mailing Address - Phone:951-340-3402
Mailing Address - Fax:951-340-3416
Practice Address - Street 1:886 MAGNOLIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3128
Practice Address - Country:US
Practice Address - Phone:951-340-3402
Practice Address - Fax:951-340-3416
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206698OtherWA DEPT OF LABOR
P00213740OtherRAILROAD MEDICARE
CAOPT275970OtherBLUE SHIELD
WA0206698OtherWA DEPT OF LABOR
OPT275970Medicare ID - Type Unspecified