Provider Demographics
NPI:1366506792
Name:THORNE-THOMSEN, ARIC (PT)
Entity Type:Individual
Prefix:MR
First Name:ARIC
Middle Name:
Last Name:THORNE-THOMSEN
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 1:420 N HIGGINS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4524
Mailing Address - Country:US
Mailing Address - Phone:406-542-3333
Mailing Address - Fax:406-542-3365
Practice Address - Street 1:420 N HIGGINS AVE STE B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4524
Practice Address - Country:US
Practice Address - Phone:406-542-3333
Practice Address - Fax:406-542-3365
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1517PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000061121OtherBLUE CROSS OF MONTANA
MT3401768Medicaid
MT202520389OtherEIN
MT202520389OtherEIN