Provider Demographics
NPI:1710748827
Name:THOMAS, KEVIN A (LMT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19510B PECK AVE # 10B
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2857
Mailing Address - Country:US
Mailing Address - Phone:347-256-5906
Mailing Address - Fax:
Practice Address - Street 1:21315 33RD RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1508
Practice Address - Country:US
Practice Address - Phone:718-962-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist