Healthcare Provider Details

I. General information

NPI: 1568560100
Provider Name (Legal Business Name): KATHERINE D. THORNE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 CAMERADO DRIVE
CAMERON PARK CA
95682-7600
US

IV. Provider business mailing address

1060 CAMERADO DRIVE
CAMERON PARK CA
95682-7600
US

V. Phone/Fax

Practice location:
  • Phone: 530-676-7184
  • Fax: 530-676-7138
Mailing address:
  • Phone: 530-676-7184
  • Fax: 530-676-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 23708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: