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NPI Code Detail

MEDICARE: STEPHEN J THRO PT

MEDICARE: STEPHEN J THRO PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist01819MO

General Provider Information

NPI Number : 1245284298
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN J THRO PT
Provider Business Mailing Address
First Line : 607 DEWEY AVE NW
Second Line : STE 300
City : GRAND RAPIDS
State : MI
Zip : 49504-7335
Country : US
Telephone Number : 616-356-5000
Fax Number : 616-356-5001
Provider Business Practice Location Address
First Line : 9331 PHOENIX VILLAGE PKWY
Second Line :
City : O FALLON
State : MO
Zip : 63368-4281
Country : US
Telephone Number : 636-561-4793
Fax Number : 636-561-4811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 02/06/2017

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