Provider Demographics
NPI:1215227780
Name:MASTERS, THOMAS (CP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MASTERS
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17931 PIERCE PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2654
Mailing Address - Country:US
Mailing Address - Phone:402-933-1393
Mailing Address - Fax:402-933-1899
Practice Address - Street 1:17931 PIERCE PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2654
Practice Address - Country:US
Practice Address - Phone:402-933-1393
Practice Address - Fax:402-933-1899
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECP003241224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE16982594OtherPERSONAL-UNIQUE