Provider Demographics
NPI:1689852873
Name:THURSTON, PRESTON WAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:WAYNE
Last Name:THURSTON
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 1:15 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2751
Mailing Address - Country:US
Mailing Address - Phone:609-610-3690
Mailing Address - Fax:215-321-2162
Practice Address - Street 1:15 LUDLOW RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-2751
Practice Address - Country:US
Practice Address - Phone:609-610-3690
Practice Address - Fax:215-321-2162
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA02724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist