Provider Demographics
NPI:1538648753
Name:THORNSBERRY, CURTIS (LMP)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:THORNSBERRY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4143
Mailing Address - Country:US
Mailing Address - Phone:425-760-6125
Mailing Address - Fax:
Practice Address - Street 1:11419 19TH AVE SE STE A109
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5120
Practice Address - Country:US
Practice Address - Phone:425-379-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60822900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60822900Medicaid