Healthcare Provider Details

I. General information

NPI: 1295726297
Provider Name (Legal Business Name): BRIAN J THORNTON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 MAPLE AVE
ALTAMONT NY
12009-0426
US

IV. Provider business mailing address

PO BOX 426
ALTAMONT NY
12009-0426
US

V. Phone/Fax

Practice location:
  • Phone: 518-861-6608
  • Fax: 518-861-6573
Mailing address:
  • Phone: 518-861-6608
  • Fax: 518-861-6573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0105091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: