Provider Demographics
NPI:1972102317
Name:PRATHER, THOMAS (CNS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PRATHER
Suffix:
Gender:M
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GAEBEL LN
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-9117
Mailing Address - Country:US
Mailing Address - Phone:302-897-2621
Mailing Address - Fax:
Practice Address - Street 1:7 GAEBEL LN
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-9117
Practice Address - Country:US
Practice Address - Phone:302-897-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5248133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty