Provider Demographics
NPI:1043412968
Name:THORNHILL, MICHELLE J (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:THORNHILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3042
Practice Address - Country:US
Practice Address - Phone:585-271-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028307OtherLICENSE
NY141731786OtherHOSPITAL TAX ID #
NY141731786OtherHOSPITAL TAX ID #
NY33U079Medicare ID - Type UnspecifiedHOSPITAL MCR SWING BED #
NY00363213Medicare ID - Type UnspecifiedHOSPITAL MEDICAID #