Provider Demographics
NPI:1629395439
Name:THOMAS, NOEL (PT)
Entity Type:Individual
Prefix:MR
First Name:NOEL
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 1:800 BONAVENTURE WAY STE 167
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8007
Mailing Address - Country:US
Mailing Address - Phone:832-559-2900
Mailing Address - Fax:
Practice Address - Street 1:800 BONAVENTURE WAY STE 167
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8007
Practice Address - Country:US
Practice Address - Phone:832-559-2900
Practice Address - Fax:832-559-2900
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X, 2251N0400X, 2251X0800X
TX1178237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX417990501Medicaid
TX1I1913OtherMEDICARE PIN