Provider Demographics
NPI:1003271511
Name:CARTER, THOMEISHA
Entity Type:Individual
Prefix:
First Name:THOMEISHA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 LIKINS CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4202
Mailing Address - Country:US
Mailing Address - Phone:773-663-5764
Mailing Address - Fax:
Practice Address - Street 1:4811 LIKINS CIR APT 204
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4202
Practice Address - Country:US
Practice Address - Phone:773-663-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT122732225700000X
IL227.015879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist