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General NPI Number Information
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NPI Number | 1487181608
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Entity Type | Individual
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Provider Name | MITCHELL T. THORSEN PT
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Gender | Male
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Dates
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Enumeration Date | 05/18/2017
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Last Update Date | 05/18/2017
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Provider Practice Location Address
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Address Line | 1118 HAMPSHIRE ST
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City | QUINCY
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State | IL
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Zip | 62301-3027
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Country | US
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Telephone | 217-222-6550
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Fax | 217-222-6550
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Provider Business Mailing Address
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Address Line | 1025 MAINE ST
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City | QUINCY
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State | IL
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Zip | 62301-4038
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Country | US
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Telephone | 12172226550
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Fax | 217-277-2253
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070022941
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License Number State | IL
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