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General NPI Number Information
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NPI Number | 1518920214
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Entity Type | Individual
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Provider Name | MS. JEAN M THORN
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 2415 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3322
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Country | US
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Telephone | 423-622-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3322
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Country | US
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Telephone | 423-624-2696
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Fax | 426-697-2055
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT1130
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License Number State | TN
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