MEDICARE: MAUREEN THORNBY

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	261QP2000X	Physical Therapy Clinic/Center	PT21392	FL

General Provider Information

NPI Number	:	1790190783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN THORNBY

Provider Business Mailing Address
First Line	:	2722 MANATEE AVE W
Second Line	:	SUITE 2
City	:	BRADENTON
State	:	FL
Zip	:	34205-4945
Country	:	US
Telephone Number	:	941-744-9046
Fax Number	:	941-567-4029

Provider Business Practice Location Address
First Line	:	506 4TH AVE W
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-5203
Country	:	US
Telephone Number	:	941-729-1800
Fax Number	:	941-722-7844

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

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	06/27/2014

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Directions to “ MAUREEN THORNBY ” Practice Location

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