Provider Demographics
NPI:1114224011
Name:THOMAS, DEDRA DENEEN (CMA, LMP)
Entity Type:Individual
Prefix:
First Name:DEDRA
Middle Name:DENEEN
Last Name:THOMAS
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Gender:F
Credentials:CMA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9074 ELK GROVE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2073
Mailing Address - Country:US
Mailing Address - Phone:916-689-4043
Mailing Address - Fax:916-682-7273
Practice Address - Street 1:9074 ELK GROVE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2073
Practice Address - Country:US
Practice Address - Phone:916-689-4043
Practice Address - Fax:916-682-7273
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist