Provider Demographics
NPI:1417764978
Name:THORNE, PRESTON S
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:S
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 1:149 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7122
Mailing Address - Country:US
Mailing Address - Phone:214-769-5087
Mailing Address - Fax:
Practice Address - Street 1:1908 TALL PINES CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-4957
Practice Address - Country:US
Practice Address - Phone:214-769-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care