Provider Demographics
NPI:1245284298
Name:THRO, STEPHEN J (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:THRO
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:607 DEWEY AVE NW
Mailing Address - Street 2:STE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-7335
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:9331 PHOENIX VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4281
Practice Address - Country:US
Practice Address - Phone:636-561-4793
Practice Address - Fax:636-561-4811
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2017-02-06
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Provider Licenses
StateLicense IDTaxonomies
MO01819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00193906Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO990101643Medicare ID - Type Unspecified