Provider Demographics
NPI:1366688475
Name:THORNE, KATHLEEN (RN, LMT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:THORNE
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 NW 234TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-4151
Mailing Address - Country:US
Mailing Address - Phone:352-318-4210
Mailing Address - Fax:386-462-2996
Practice Address - Street 1:5525 NW 234TH AVE
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-4151
Practice Address - Country:US
Practice Address - Phone:352-318-4210
Practice Address - Fax:386-462-2996
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist