Provider Demographics
NPI:1295829612
Name:THORN, ELIZABETH STREET (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:STREET
Last Name:THORN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:WHITTEN
Other - Last Name:STREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4524 SOUTHLAKE PARKWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-988-8542
Mailing Address - Fax:205-988-8498
Practice Address - Street 1:4524 SOUTHLAKE PARKWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-988-8542
Practice Address - Fax:205-988-8498
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist