Provider Demographics
NPI:1568538130
Name:THOMAS, TIM L (PT)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:L
Last Name:THOMAS
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:PO BOX 994108
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4108
Mailing Address - Country:US
Mailing Address - Phone:530-243-1102
Mailing Address - Fax:
Practice Address - Street 1:1706 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0236
Practice Address - Country:US
Practice Address - Phone:530-243-1102
Practice Address - Fax:530-243-1123
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist