Provider Demographics
NPI:1194746370
Name:THORNHILL, JACQUELINE N (PT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:N
Last Name:THORNHILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:N
Other - Last Name:ATHAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:100 VINEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9813
Mailing Address - Country:US
Mailing Address - Phone:516-637-5440
Mailing Address - Fax:
Practice Address - Street 1:100 VINEWOOD PL
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9813
Practice Address - Country:US
Practice Address - Phone:516-637-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14270225100000X
TX1167870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00433569Medicare PIN
TX8G7169Medicare PIN