Provider Demographics
NPI:1508806803
Name:FLANAGAN, THOMAS C (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:FLANAGAN
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 1:1333 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1149
Mailing Address - Country:US
Mailing Address - Phone:607-648-4646
Mailing Address - Fax:607-648-4647
Practice Address - Street 1:1333 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1149
Practice Address - Country:US
Practice Address - Phone:607-648-4646
Practice Address - Fax:607-648-4647
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021728-1225100000X
NY021728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021728-1OtherNYS LICENSE
NY02544530Medicaid