MEDICARE: SASHA IRENE THORNOCK L.M.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	172M00000X	Mechanotherapist	5499	NM

General Provider Information

NPI Number	:	1942450150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SASHA IRENE THORNOCK L.M.T.

Provider Business Mailing Address
First Line	:	2848 BORROUGHS ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-1954
Country	:	US
Telephone Number	:	575-527-5130
Fax Number	:

Provider Business Practice Location Address
First Line	:	3961 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8269
Country	:	US
Telephone Number	:	575-525-9960
Fax Number	:	575-525-9958

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

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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