Provider Demographics
| NPI: | 1811203557 |
|---|---|
| Name: | THORNTON, GLENN ALLEN JR (RCP) |
| Entity Type: | Individual |
| Prefix: | MR |
| First Name: | GLENN |
| Middle Name: | ALLEN |
| Last Name: | THORNTON |
| Suffix: | JR |
| Gender: | M |
| Credentials: | RCP |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 2104 CAMINO DE LAS PALMAS |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LEMON GROVE |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 91945-3334 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 619-737-6219 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2104 CAMINO DE LAS PALMAS |
| Practice Address - Street 2: | |
| Practice Address - City: | LEMON GROVE |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 91945-3334 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 619-737-6219 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2010-08-19 |
| Last Update Date: | 2010-08-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CA | 00028731 | 227800000X |
| 2278C0205X, 2278E0002X, 2278E1000X, 2278G0305X, 2278H0200X, 2278P1005X, 2278P4000X, 2279G1100X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 227800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | |
| No | 2278C0205X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Critical Care |
| No | 2278E0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Emergency Care |
| No | 2278E1000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Educational |
| No | 2278G0305X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Geriatric Care |
| No | 2278H0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Home Health |
| No | 2278P1005X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Pulmonary Rehabilitation |
| No | 2278P4000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Patient Transport |
| No | 2279G1100X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | General Care |
