Provider Demographics
NPI:1336481274
Name:THORLEY, TIINA M (MPA, PA-C, RRT)
Entity Type:Individual
Prefix:MRS
First Name:TIINA
Middle Name:M
Last Name:THORLEY
Suffix:
Gender:F
Credentials:MPA, PA-C, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5169 S COTTONWOOD ST
Mailing Address - Street 2:BUILDING 2, SUITE 510
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6767
Mailing Address - Country:US
Mailing Address - Phone:801-507-3513
Mailing Address - Fax:
Practice Address - Street 1:5169 S COTTONWOOD ST
Practice Address - Street 2:BUILDING 2, SUITE 510
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6358658-1206363A00000X
CAPA22848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant