Provider Demographics
NPI:1215202916
Name:THOMAS, PERRY
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 COUNTY HIGHWAY 147 W
Mailing Address - Street 2:
Mailing Address - City:LAUREL HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32567-3233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 COUNTY HIGHWAY 147 W
Practice Address - Street 2:
Practice Address - City:LAUREL HILL
Practice Address - State:FL
Practice Address - Zip Code:32567-3233
Practice Address - Country:US
Practice Address - Phone:850-834-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2274227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified