Provider Demographics
NPI:1033156047
Name:THOMAS, CHARLES J (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 E 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-4125
Mailing Address - Country:US
Mailing Address - Phone:509-363-0914
Mailing Address - Fax:
Practice Address - Street 1:1605 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2620
Practice Address - Country:US
Practice Address - Phone:509-444-8383
Practice Address - Fax:509-444-8385
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6227THOtherASURIS NORTHWEST HEALTH
WA8859777Medicare PIN
WA6227THOtherASURIS NORTHWEST HEALTH