Provider Demographics
NPI:1689615783
Name:THORESON, JON (PT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:THORESON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 WHITE POST RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5456
Mailing Address - Country:US
Mailing Address - Phone:563-332-0684
Mailing Address - Fax:
Practice Address - Street 1:520 VALLEY VIEW DR
Practice Address - Street 2:STE 200
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6152
Practice Address - Country:US
Practice Address - Phone:306-797-0866
Practice Address - Fax:309-797-0872
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist