Healthcare Provider Details

I. General information

NPI: 1740102193
Provider Name (Legal Business Name): TERRY HUNTER THORNTON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6859 BELFORT OAKS PL FL 32216
JACKSONVILLE FL
32216-6242
US

IV. Provider business mailing address

PO BOX 360595, PITTSBURGH PA 15251
PITTSBURGH PA
15251-0001
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-5311
  • Fax: 718-865-5165
Mailing address:
  • Phone: 718-215-5311
  • Fax: 718-865-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2832191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: