Provider Demographics
NPI:1255891891
Name:THORNSBERRY, DANIELLE JUSTINE (DO)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JUSTINE
Last Name:THORNSBERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:740-566-4720
Mailing Address - Fax:740-566-4721
Practice Address - Street 1:75 HOSPITAL DR STE 140
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2858
Practice Address - Country:US
Practice Address - Phone:740-566-4720
Practice Address - Fax:740-566-4721
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-47756207QS0010X
OH34.015287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine