Provider Demographics
NPI:1811707888
Name:THORNE, JEREMY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:THORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 S REDWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9271
Mailing Address - Country:US
Mailing Address - Phone:801-694-9941
Mailing Address - Fax:
Practice Address - Street 1:8817 S REDWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9271
Practice Address - Country:US
Practice Address - Phone:801-694-9941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant