Provider Demographics
NPI:1407358880
Name:THOMAS, NATHANIAL (DO)
Entity Type:Individual
Prefix:
First Name:NATHANIAL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E MAIN ST APT 2102
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1352
Mailing Address - Country:US
Mailing Address - Phone:513-464-0482
Mailing Address - Fax:
Practice Address - Street 1:2050 VERSAILLES RD STE U102
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1405
Practice Address - Country:US
Practice Address - Phone:859-257-4888
Practice Address - Fax:859-323-1123
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP806208100000X
390200000X
KY05243208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program