Provider Demographics
NPI:1194945659
Name:THORNE, SARA GATES (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:GATES
Last Name:THORNE
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N DUKE ST
Mailing Address - Street 2:#221
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-5000
Mailing Address - Country:US
Mailing Address - Phone:773-580-9716
Mailing Address - Fax:
Practice Address - Street 1:981 HIGH HOUSE RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3510
Practice Address - Country:US
Practice Address - Phone:919-388-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011679225100000X
NC13913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070011679OtherPHYSICAL THERAPY LICENSE
NC13913OtherNC PT LICENSE