Provider Demographics
NPI:1467513382
Name:THOM, JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:THOM
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 1:5233 W MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-1541
Mailing Address - Country:US
Mailing Address - Phone:414-543-8111
Mailing Address - Fax:414-543-8150
Practice Address - Street 1:5233 W MORGAN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-1541
Practice Address - Country:US
Practice Address - Phone:414-543-8111
Practice Address - Fax:414-543-8150
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1177-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40127100Medicaid
WI84-742Medicare ID - Type Unspecified