Healthcare Provider Details

I. General information

NPI: 1235919531
Provider Name (Legal Business Name): THORNTON ACCESSIBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 LAKEVIEW AVE
PUEBLO CO
81004-3659
US

IV. Provider business mailing address

1951 LAKE AVE
PUEBLO CO
81004-3321
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-5333
  • Fax: 719-623-0455
Mailing address:
  • Phone: 719-564-5333
  • Fax: 719-623-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MAYER
Title or Position: CEO
Credential:
Phone: 719-564-5333