1295829612 NPI number — MRS. ELIZABETH STREET THORN MPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295829612 NPI number — MRS. ELIZABETH STREET THORN MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORN
Provider First Name:
ELIZABETH
Provider Middle Name:
STREET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STREET
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
WHITTEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295829612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4524 SOUTHLAKE PARKWAY
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-988-8542
Provider Business Mailing Address Fax Number:
205-988-8498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4524 SOUTHLAKE PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-988-8542
Provider Business Practice Location Address Fax Number:
205-988-8498
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTH3973 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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