Provider Demographics
NPI:1639294317
Name:XENAKIS, THOMAS JOSEPH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:XENAKIS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:526 SOUTH RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-673-9300
Mailing Address - Fax:
Practice Address - Street 1:167 AVENUE AT THE CMN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4805
Practice Address - Country:US
Practice Address - Phone:732-673-9300
Practice Address - Fax:732-612-1298
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00941400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist