Provider Demographics
NPI:1578905766
Name:THORNTON, THOMAS ROGERS
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROGERS
Last Name:THORNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76-6167 ALII DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2387
Mailing Address - Country:US
Mailing Address - Phone:336-508-2572
Mailing Address - Fax:
Practice Address - Street 1:65-1230 MAMALAHOA HWY
Practice Address - Street 2:E 11
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8318
Practice Address - Country:US
Practice Address - Phone:808-885-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist