Provider Demographics
NPI:1285969519
Name:THORNE, JEFFERY
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:THORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 E BAYWOOD AVE
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1723
Mailing Address - Country:US
Mailing Address - Phone:480-396-9020
Mailing Address - Fax:
Practice Address - Street 1:6641 E BAYWOOD AVE
Practice Address - Street 2:SUITE A-4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1723
Practice Address - Country:US
Practice Address - Phone:480-396-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76390Medicare PIN