Provider Demographics
NPI:1891032470
Name:THURN, MARISA CATHERINE (LMT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:CATHERINE
Last Name:THURN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1140
Mailing Address - Country:US
Mailing Address - Phone:317-514-5089
Mailing Address - Fax:317-677-8691
Practice Address - Street 1:1301 FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-1140
Practice Address - Country:US
Practice Address - Phone:317-514-5089
Practice Address - Fax:317-677-8691
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20900414225700000X
INQ4X8C6F4246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist