Provider Demographics
NPI:1902137995
Name:THORNTON, STACEE CHRISTINE (CMF)
Entity Type:Individual
Prefix:
First Name:STACEE
Middle Name:CHRISTINE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NEWSOM ST STE 105
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2197
Mailing Address - Country:US
Mailing Address - Phone:919-471-9891
Mailing Address - Fax:919-477-1235
Practice Address - Street 1:105 NEWSOM ST STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2197
Practice Address - Country:US
Practice Address - Phone:919-471-9891
Practice Address - Fax:919-477-1235
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC46877225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter