Provider Demographics
NPI:1679098149
Name:TRAVERS, THOMAS (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:TRAVERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HARBOUR PLACE DR APT 1413
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-6755
Mailing Address - Country:US
Mailing Address - Phone:516-865-2745
Mailing Address - Fax:
Practice Address - Street 1:401 HARBOUR PLACE DR APT 1413
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-6755
Practice Address - Country:US
Practice Address - Phone:516-865-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042877225100000X
FLPT32854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32854OtherDEPARTMENT OF HEALTH