MEDICARE: MRS. STACIE LYNN THORNTON P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT018070	PA

General Provider Information

NPI Number	:	1699912527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACIE LYNN THORNTON P.T.

Provider Business Mailing Address
First Line	:	1327 KATHERINE LN
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-6207
Country	:	US
Telephone Number	:	610-738-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1327 KATHERINE LN
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-6207
Country	:	US
Telephone Number	:	610-738-4278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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