Healthcare Provider Details

I. General information

NPI: 1255891891
Provider Name (Legal Business Name): DANIELLE JUSTINE THORNSBERRY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOSPITAL DR STE 140
ATHENS OH
45701-2858
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-566-4720
  • Fax: 740-566-4721
Mailing address:
  • Phone: 740-566-4720
  • Fax: 740-566-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number05-47756
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.015287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: