Provider Demographics
NPI:1407295181
Name:THOMAS, ANNA (PT,DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1273 N EMERSON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6672
Practice Address - Country:US
Practice Address - Phone:317-807-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011195A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist