Provider Demographics
NPI:1790264273
Name:MAURO, THOMAS RAYMOND JR (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RAYMOND
Last Name:MAURO
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416501 STE 140
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2401
Mailing Address - Country:US
Mailing Address - Phone:910-294-4050
Mailing Address - Fax:631-760-8303
Practice Address - Street 1:10787 RANDOLPH ST STE 220
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46307-7615
Practice Address - Country:US
Practice Address - Phone:219-333-5900
Practice Address - Fax:219-359-2123
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21810225100000X
VA2305215631225100000X
MD27316225100000X
PAPT027136225100000X
COPTL.0019238225100000X
IN05015458A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist