Provider Demographics
NPI:1689795437
Name:TOLSON, THOMAS D (PT,ECS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:TOLSON
Suffix:
Gender:M
Credentials:PT,ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 ROUTE 212
Mailing Address - Street 2:APT 2
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-3322
Mailing Address - Country:US
Mailing Address - Phone:215-249-0920
Mailing Address - Fax:215-249-1163
Practice Address - Street 1:150 MUNDY ST
Practice Address - Street 2:STE 2
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6830
Practice Address - Country:US
Practice Address - Phone:570-288-7181
Practice Address - Fax:570-288-7633
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002678L2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116270Medicare ID - Type Unspecified