Provider Demographics
NPI:1790752418
Name:WASHINGTON, THOMAS IRVIN (PT, MBA, ATC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:IRVIN
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PT, MBA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12758 CIMARRON PATH
Mailing Address - Street 2:STE 126
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3498
Mailing Address - Country:US
Mailing Address - Phone:210-615-8844
Mailing Address - Fax:210-615-6959
Practice Address - Street 1:12758 CIMARRON PATH
Practice Address - Street 2:STE 126
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3498
Practice Address - Country:US
Practice Address - Phone:210-615-8844
Practice Address - Fax:210-615-6959
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022770225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790152418OtherNPI
TXR69368Medicare UPIN
TX1790152418OtherNPI