=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386960953
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY THRONEBURG BC-HIS, ACA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2010
-----------------------------------------------------
Last Update Date | 04/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13517 US HIGHWAY 1 STE F
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-3759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-589-1749
-----------------------------------------------------
Fax | 772-589-7005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13517 US HIGHWAY 1 STE F
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-3759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-589-1749
-----------------------------------------------------
Fax | 772-589-7005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | AS0002090
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------