Provider Demographics
NPI:1346203320
Name:THURSTON, DEIRDRE L (ATC)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:L
Last Name:THURSTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 ELBERTA LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1349
Mailing Address - Country:US
Mailing Address - Phone:609-820-0374
Mailing Address - Fax:
Practice Address - Street 1:235 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-4001
Practice Address - Country:US
Practice Address - Phone:609-654-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001299002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer