Healthcare Provider Details

I. General information

NPI: 1992082234
Provider Name (Legal Business Name): ASHLEY LYNN THORN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 06/22/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SEMINARY AVE UNIT 3
CHESTER NJ
07930-2614
US

IV. Provider business mailing address

30 SEMINARY AVE UNIT 3
CHESTER NJ
07930-2614
US

V. Phone/Fax

Practice location:
  • Phone: 908-955-7616
  • Fax: 908-955-7408
Mailing address:
  • Phone: 908-955-7616
  • Fax: 908-955-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01424200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: