Provider Demographics
NPI:1831624626
Name:THORNTON, CATRICE MORNING BIRD (LMT)
Entity type:Individual
Prefix:
First Name:CATRICE
Middle Name:MORNING BIRD
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 BRETON RD SE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5572
Mailing Address - Country:US
Mailing Address - Phone:616-613-6442
Mailing Address - Fax:
Practice Address - Street 1:2050 BRETON RD SE
Practice Address - Street 2:SUITE 109
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5572
Practice Address - Country:US
Practice Address - Phone:616-613-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-29
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501009142225700000X
175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No175F00000XOther Service ProvidersNaturopath