Provider Demographics
NPI:1295726297
Name:THORNTON, BRIAN J (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:THORNTON
Suffix:
Gender:M
Credentials:PT
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 426
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-0426
Mailing Address - Country:US
Mailing Address - Phone:518-861-6608
Mailing Address - Fax:518-861-6573
Practice Address - Street 1:122 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009-0426
Practice Address - Country:US
Practice Address - Phone:518-861-6608
Practice Address - Fax:518-861-6573
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0105091208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB6301Medicare PIN