Provider Demographics
NPI:1710985668
Name:THOMAS, DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 MAIN ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1800
Mailing Address - Country:US
Mailing Address - Phone:978-851-8768
Mailing Address - Fax:
Practice Address - Street 1:885 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1800
Practice Address - Country:US
Practice Address - Phone:978-851-8768
Practice Address - Fax:978-851-8606
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705837Medicaid
MA0705837Medicaid
Y6924701Medicare PIN