Provider Demographics
NPI:1730460056
Name:VAETH, THOMAS DOUGLAS (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DOUGLAS
Last Name:VAETH
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 1:2 E ROLLING XRDS STE 57
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6212
Mailing Address - Country:US
Mailing Address - Phone:443-860-9168
Mailing Address - Fax:443-636-5987
Practice Address - Street 1:2 E ROLLING XRDS STE 57
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6212
Practice Address - Country:US
Practice Address - Phone:443-860-9168
Practice Address - Fax:443-860-9168
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist