Provider Demographics
NPI:1689233694
Name:RAMAGE, THOMAS JOHN IV (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:RAMAGE
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 N MILDRED RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2212
Mailing Address - Country:US
Mailing Address - Phone:970-564-0311
Mailing Address - Fax:970-564-0313
Practice Address - Street 1:2400 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4509
Practice Address - Country:US
Practice Address - Phone:505-326-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016730225100000X
NMPT4784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty