Provider Demographics
NPI:1417250333
Name:TOOMBS, PHILLIP A (PT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:TOOMBS
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 1:12 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5012
Practice Address - Country:US
Practice Address - Phone:845-279-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist