Provider Demographics
NPI:1073790101
Name:NORTH, THOMAS V (LMT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:V
Last Name:NORTH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 PRENDERGAST AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5322
Mailing Address - Country:US
Mailing Address - Phone:716-483-0504
Mailing Address - Fax:
Practice Address - Street 1:512 PRENDERGAST AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5322
Practice Address - Country:US
Practice Address - Phone:716-483-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist