Provider Demographics
NPI:1942758065
Name:THAYNE, ELIZABETH ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:THAYNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:BLATTEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:623 S CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-2315
Mailing Address - Country:US
Mailing Address - Phone:610-543-1201
Mailing Address - Fax:610-328-5205
Practice Address - Street 1:30 LIBERTY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1418
Practice Address - Country:US
Practice Address - Phone:484-321-8660
Practice Address - Fax:484-321-8657
Is Sole Proprietor?:No
Enumeration Date:2016-09-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist