Provider Demographics
NPI:1851401079
Name:THORNTON, JAIME LYNN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LYNN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:910 CITY PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206
Mailing Address - Country:US
Mailing Address - Phone:614-449-8008
Mailing Address - Fax:
Practice Address - Street 1:4019 W DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1436
Practice Address - Country:US
Practice Address - Phone:614-293-0043
Practice Address - Fax:614-293-6962
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist