Provider Demographics
NPI:1053119701
Name:THOR, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:THOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4986 STATE HIGHWAY 156
Mailing Address - Street 2:
Mailing Address - City:BONDUEL
Mailing Address - State:WI
Mailing Address - Zip Code:54107-8601
Mailing Address - Country:US
Mailing Address - Phone:920-570-3795
Mailing Address - Fax:
Practice Address - Street 1:W4986 STATE HIGHWAY 156
Practice Address - Street 2:
Practice Address - City:BONDUEL
Practice Address - State:WI
Practice Address - Zip Code:54107-8601
Practice Address - Country:US
Practice Address - Phone:920-570-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)