Healthcare Provider Details

I. General information

NPI: 1578905766
Provider Name (Legal Business Name): DR. THOMAS ROGERS THORNTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1230 MAMALAHOA HWY E 11
KAMUELA HI
96743-8318
US

IV. Provider business mailing address

76-6167 ALII DR
KAILUA KONA HI
96740-2387
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-7131
  • Fax:
Mailing address:
  • Phone: 336-508-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: