Healthcare Provider Details

I. General information

NPI: 1972826295
Provider Name (Legal Business Name): DEANNA LYNN THORNTON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 N HIGH ST
EAST HAVEN CT
06512-1555
US

IV. Provider business mailing address

451 N HIGH ST
EAST HAVEN CT
06512-1555
US

V. Phone/Fax

Practice location:
  • Phone: 203-466-6850
  • Fax: 203-466-6852
Mailing address:
  • Phone: 203-466-6850
  • Fax: 203-466-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007135
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9643
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: