Provider Demographics
NPI:1114281318
Name:THOMAS, JARED C (LMT,CPT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMT,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 WALNUT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1157
Mailing Address - Country:US
Mailing Address - Phone:857-249-0232
Mailing Address - Fax:
Practice Address - Street 1:161 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-1307
Practice Address - Country:US
Practice Address - Phone:857-249-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156890225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist