Provider Demographics
NPI:1811222946
Name:DRYSDALE, THOMAS ADAM
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ADAM
Last Name:DRYSDALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BLACKTHORN DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6368
Mailing Address - Country:US
Mailing Address - Phone:815-343-3917
Mailing Address - Fax:
Practice Address - Street 1:1900 BLACKTHORN DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-6368
Practice Address - Country:US
Practice Address - Phone:815-343-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor