Healthcare Provider Details

I. General information

NPI: 1053584318
Provider Name (Legal Business Name): TONYA THORNE CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E MAIN ST
HART MI
49420-1144
US

IV. Provider business mailing address

360 3RD AVE APT. B-1
PENTWATER MI
49449-9518
US

V. Phone/Fax

Practice location:
  • Phone: 231-873-3577
  • Fax: 231-873-3557
Mailing address:
  • Phone: 231-869-9020
  • Fax: 231-873-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: