Provider Demographics
NPI:1285823815
Name:KANE, THOMAS A (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:KANE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0586
Mailing Address - Country:US
Mailing Address - Phone:850-656-1837
Mailing Address - Fax:
Practice Address - Street 1:2615 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0586
Practice Address - Country:US
Practice Address - Phone:850-656-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3028OtherMEDICARE PROVIDER