=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376526020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REX E THORNHILL DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2005
-----------------------------------------------------
Last Update Date | 03/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 806 9TH ST. SUITE 2C
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-239-3136
-----------------------------------------------------
Fax | 805-239-3137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 806 9TH ST SUITE 2C
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-239-3136
-----------------------------------------------------
Fax | 805-239-3137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 000E3592
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0263310002
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | E3592
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------