Provider Demographics
NPI:1518398858
Name:THORNTON, MARIA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MARGARET LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5261
Mailing Address - Country:US
Mailing Address - Phone:530-273-7500
Mailing Address - Fax:530-273-7551
Practice Address - Street 1:104 MARGARET LN
Practice Address - Street 2:SUITE B
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5261
Practice Address - Country:US
Practice Address - Phone:530-273-7500
Practice Address - Fax:530-273-7551
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist