Provider Demographics
NPI:1225581895
Name:THOMAS, LEA (AUD)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 CORTEZ BLVD
Mailing Address - Street 2:137
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6319
Mailing Address - Country:US
Mailing Address - Phone:352-666-8911
Mailing Address - Fax:352-683-6889
Practice Address - Street 1:10045 CORTEZ BLVD
Practice Address - Street 2:137
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-6319
Practice Address - Country:US
Practice Address - Phone:352-666-8911
Practice Address - Fax:352-683-6889
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2066231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist