Provider Demographics
NPI:1528537958
Name:THOMAS, JONATHAN (PTA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SPRING VALLEY COMMONS
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4249
Mailing Address - Country:US
Mailing Address - Phone:845-825-7319
Mailing Address - Fax:
Practice Address - Street 1:10 LINK DR
Practice Address - Street 2:
Practice Address - City:ROCKLEIGH
Practice Address - State:NJ
Practice Address - Zip Code:07647-2504
Practice Address - Country:US
Practice Address - Phone:201-784-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00349600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant