Provider Demographics
NPI:1770584351
Name:THORNTON, KATHLEEN P (ATC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:P
Last Name:THORNTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SHELBURNE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-3036
Mailing Address - Country:US
Mailing Address - Phone:508-998-0594
Mailing Address - Fax:
Practice Address - Street 1:49 STATE RD
Practice Address - Street 2:MASHPEE BUILDING
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3322
Practice Address - Country:US
Practice Address - Phone:508-910-3434
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer