Provider Demographics
NPI:1699912527
Name:THORNTON, STACIE LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:LYNN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:STACIE
Other - Middle Name:LYNN
Other - Last Name:CHASZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1327 KATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6207
Mailing Address - Country:US
Mailing Address - Phone:610-738-4278
Mailing Address - Fax:
Practice Address - Street 1:1327 KATHERINE LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6207
Practice Address - Country:US
Practice Address - Phone:610-738-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist