Provider Demographics
NPI:1679578959
Name:THOMAS, RAEANN SUSAN (PT, MPT)
Entity Type:Individual
Prefix:
First Name:RAEANN
Middle Name:SUSAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 OLD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1537
Mailing Address - Country:US
Mailing Address - Phone:405-820-5075
Mailing Address - Fax:
Practice Address - Street 1:3699 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6559
Practice Address - Country:US
Practice Address - Phone:405-387-5520
Practice Address - Fax:405-387-5404
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist