Healthcare Provider Details

I. General information

NPI: 1891032470
Provider Name (Legal Business Name): MARISA CATHERINE THURN L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FLETCHER AVE
INDIANAPOLIS IN
46203-1140
US

IV. Provider business mailing address

1301 FLETCHER AVE
INDIANAPOLIS IN
46203-1140
US

V. Phone/Fax

Practice location:
  • Phone: 317-514-5089
  • Fax: 317-677-8691
Mailing address:
  • Phone: 317-514-5089
  • Fax: 317-677-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT20900414
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberQ4X8C6F4
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: