Provider Demographics
NPI:1861507493
Name:THORNTON, KACY J (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KACY
Middle Name:J
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:KACY
Other - Middle Name:J
Other - Last Name:BLUMENSTOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4211 JOE RAMSEY BLVD E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7852
Mailing Address - Country:US
Mailing Address - Phone:903-408-7700
Mailing Address - Fax:903-408-7802
Practice Address - Street 1:4211 JOE RAMSEY BLVD E
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:903-408-7700
Practice Address - Fax:903-408-7802
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist