Provider Demographics
NPI:1619119153
Name:PFAFF, THOMAS RICHARD (LMT, CPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:PFAFF
Suffix:
Gender:M
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 SCENIC GULF DR
Mailing Address - Street 2:SUITE LS-1
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-4028
Mailing Address - Country:US
Mailing Address - Phone:850-543-7905
Mailing Address - Fax:
Practice Address - Street 1:1096 SCENIC GULF DR
Practice Address - Street 2:SUITE LS-1
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-4028
Practice Address - Country:US
Practice Address - Phone:850-543-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist