=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861087322
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOPHIA ANNA THORMAN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2021
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2141 LAKE AVE
-----------------------------------------------------
City | ASHTABULA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44004-3435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-443-0442
-----------------------------------------------------
Fax | 440-755-8010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29111 CEDAR RD
-----------------------------------------------------
City | MAYFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-646-1600
-----------------------------------------------------
Fax | 440-646-1505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------