Provider Demographics
NPI:1619320850
Name:THOMAS, WHITFORD (PT)
Entity Type:Individual
Prefix:
First Name:WHITFORD
Middle Name:
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 1:2609 W CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4310
Mailing Address - Country:US
Mailing Address - Phone:903-718-0762
Mailing Address - Fax:
Practice Address - Street 1:4897 HIGHWAY 121
Practice Address - Street 2:SUITE 140
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2911
Practice Address - Country:US
Practice Address - Phone:469-362-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3119260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist