Provider Demographics
NPI:1447539184
Name:THORSTAD, ANNA MARIA (PT)
Entity type:Individual
Prefix:
First Name:ANNA MARIA
Middle Name:
Last Name:THORSTAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3494 N VICTOR RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8464
Mailing Address - Country:US
Mailing Address - Phone:310-529-3398
Mailing Address - Fax:
Practice Address - Street 1:3494 N VICTOR RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8464
Practice Address - Country:US
Practice Address - Phone:310-529-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist