Provider Demographics
NPI:1194078949
Name:THRASHER, JAN MARIE (PT)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:MARIE
Last Name:THRASHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 OCCANECCHI TRL
Mailing Address - Street 2:
Mailing Address - City:EBONY
Mailing Address - State:VA
Mailing Address - Zip Code:23845-2035
Mailing Address - Country:US
Mailing Address - Phone:434-636-4058
Mailing Address - Fax:434-636-4058
Practice Address - Street 1:701 SIOUAN RD
Practice Address - Street 2:
Practice Address - City:EBONY
Practice Address - State:VA
Practice Address - Zip Code:23845-2050
Practice Address - Country:US
Practice Address - Phone:434-955-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202280225100000X
NC5391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist