Provider Demographics
NPI:1598985319
Name:MESSINA, THOMAS JOHN (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:MESSINA
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 5394
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-0394
Mailing Address - Country:US
Mailing Address - Phone:817-910-9634
Mailing Address - Fax:
Practice Address - Street 1:6913 RUNNING DEER CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-2413
Practice Address - Country:US
Practice Address - Phone:817-910-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11144032251X0800X
NM33082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic