Provider Demographics
NPI:1134673221
Name:THOMAS, JEREMY (ATC, DPT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:ATC, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8946 MAIN ST APT 31
Mailing Address - Street 2:
Mailing Address - City:MC KEAN
Mailing Address - State:PA
Mailing Address - Zip Code:16426-1462
Mailing Address - Country:US
Mailing Address - Phone:412-657-2927
Mailing Address - Fax:
Practice Address - Street 1:109 UNIVERSITY SQ
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16541-0002
Practice Address - Country:US
Practice Address - Phone:814-571-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-07
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAPT027708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program