Healthcare Provider Details

I. General information

NPI: 1902137995
Provider Name (Legal Business Name): STACEE CHRISTINE THORNTON CMF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NEWSOM ST STE 105
DURHAM NC
27704-2197
US

IV. Provider business mailing address

105 NEWSOM ST STE 105
DURHAM NC
27704-2197
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-9891
  • Fax: 919-477-1235
Mailing address:
  • Phone: 919-471-9891
  • Fax: 919-477-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC46877
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: