Provider Demographics
NPI:1982855490
Name:THOMAS, TODD (MS, PT)
Entity Type:Individual
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First Name:TODD
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, PT
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Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:1701 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-1463
Practice Address - Country:US
Practice Address - Phone:570-752-2925
Practice Address - Fax:570-752-3190
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2015-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPT007640L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396749Medicare PIN