Provider Demographics
NPI:1518697531
Name:THOMAS, DESTINY (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:809 CHENNAULT LN
Mailing Address - Street 2:
Mailing Address - City:WHITEMAN AFB
Mailing Address - State:MO
Mailing Address - Zip Code:65305-1121
Mailing Address - Country:US
Mailing Address - Phone:318-243-0561
Mailing Address - Fax:
Practice Address - Street 1:809 CHENNAULT LN
Practice Address - Street 2:
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65305-1121
Practice Address - Country:US
Practice Address - Phone:318-243-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCP008850T225100000X
MSPT6089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist