Provider Demographics
NPI:1568553352
Name:THORNBURG, TERRANCE HEATH (TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:HEATH
Last Name:THORNBURG
Suffix:
Gender:M
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 S STAPLES ST APT 426
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5516
Mailing Address - Country:US
Mailing Address - Phone:716-912-7668
Mailing Address - Fax:
Practice Address - Street 1:8930 OCEAN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419-5201
Practice Address - Country:US
Practice Address - Phone:361-939-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other