Provider Demographics
NPI:1699005108
Name:THOMAS, TAMARA SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:SUE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 COUNTY ROAD 335
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-5262
Mailing Address - Country:US
Mailing Address - Phone:573-694-0350
Mailing Address - Fax:
Practice Address - Street 1:3176 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:65063-1630
Practice Address - Country:US
Practice Address - Phone:573-694-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist