Provider Demographics
NPI:1043352180
Name:THOMAS, PETER MICHAEL (DC ATC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DC ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 WAE TRL
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1642
Mailing Address - Country:US
Mailing Address - Phone:412-215-1005
Mailing Address - Fax:
Practice Address - Street 1:232 WAE TRL
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1642
Practice Address - Country:US
Practice Address - Phone:412-215-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060026952255A2300X
PADC010046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer