Provider Demographics
NPI:1073702932
Name:MCDADE, THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:MCDADE
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 1:171 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2433
Mailing Address - Country:US
Mailing Address - Phone:650-756-3740
Mailing Address - Fax:650-756-3890
Practice Address - Street 1:171 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2433
Practice Address - Country:US
Practice Address - Phone:650-756-3740
Practice Address - Fax:650-756-3890
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT57700Medicare UPIN