Provider Demographics
NPI:1346365426
Name:THOMAS, ANGELA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 COACHMANS CARRIAGE TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-8512
Mailing Address - Country:US
Mailing Address - Phone:740-591-4583
Mailing Address - Fax:
Practice Address - Street 1:2002 BREMO RD STE 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2441
Practice Address - Country:US
Practice Address - Phone:804-282-3500
Practice Address - Fax:804-282-3533
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2934892Medicaid
OH000000596894OtherANTHEM
OH2934892Medicaid