Provider Demographics
NPI:1013136407
Name:THORNTON, JOSEPH (LMPO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:THORNTON
Suffix:
Gender:M
Credentials:LMPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2620
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-2620
Mailing Address - Country:US
Mailing Address - Phone:208-676-9080
Mailing Address - Fax:
Practice Address - Street 1:801 BRYDEN AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4927
Practice Address - Country:US
Practice Address - Phone:208-798-4605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA135273OtherL&I
ID8M820OtherBLUE CROSS OF IDAHO
ID000010028073OtherREGENCE BLUE SHIELD OF ID
WA9047259Medicaid