Provider Demographics
NPI:1487047528
Name:THORSON, ATHINA (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:ATHINA
Middle Name:
Last Name:THORSON
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:ATHINA
Other - Middle Name:
Other - Last Name:AJAZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 CHESNEY DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-2238
Mailing Address - Country:US
Mailing Address - Phone:630-999-0108
Mailing Address - Fax:
Practice Address - Street 1:4700 N 16TH ST APT 445
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4448
Practice Address - Country:US
Practice Address - Phone:630-990-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
AZLPT-30892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer