Provider Demographics
NPI:1942502307
Name:THOMAS, REBECCA (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 CRIMSON DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5903
Mailing Address - Country:US
Mailing Address - Phone:706-218-2372
Mailing Address - Fax:
Practice Address - Street 1:100 W WALNUT AVE
Practice Address - Street 2:SUITE 92
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8402
Practice Address - Country:US
Practice Address - Phone:706-272-2219
Practice Address - Fax:706-272-2266
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist