Provider Demographics
NPI:1568679868
Name:TOMLINSON, FRED LEHMAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:LEHMAN
Last Name:TOMLINSON
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:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-0872
Mailing Address - Country:US
Mailing Address - Phone:417-326-3768
Mailing Address - Fax:
Practice Address - Street 1:800 N ARTHUR ST
Practice Address - Street 2:
Practice Address - City:HUMANSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65674-8655
Practice Address - Country:US
Practice Address - Phone:417-754-2208
Practice Address - Fax:417-754-8092
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115857225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant