Provider Demographics
NPI:1639343056
Name:THORNTON, ANN M (PTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22341 SW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1556
Mailing Address - Country:US
Mailing Address - Phone:786-683-6350
Mailing Address - Fax:305-242-9442
Practice Address - Street 1:22341 SW 99TH AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1556
Practice Address - Country:US
Practice Address - Phone:786-683-6350
Practice Address - Fax:305-242-9442
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 657225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant