Provider Demographics
NPI:1881360451
Name:THORNTON, KAITLIN MESKE
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MESKE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 W I 20
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1042
Mailing Address - Country:US
Mailing Address - Phone:817-483-1746
Mailing Address - Fax:817-483-5874
Practice Address - Street 1:524 E LAMAR BLVD STE 130
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3929
Practice Address - Country:US
Practice Address - Phone:817-483-1746
Practice Address - Fax:817-483-5874
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1350094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1350094OtherPT LICENSE