Provider Demographics
NPI:1952657488
Name:THOMAS, PATRICIA LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:LYNN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1708 W ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4545
Mailing Address - Country:US
Mailing Address - Phone:410-578-5216
Mailing Address - Fax:410-542-8890
Practice Address - Street 1:1708 W ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4545
Practice Address - Country:US
Practice Address - Phone:410-578-5216
Practice Address - Fax:410-542-8890
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2391225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant