Provider Demographics
NPI:1013083104
Name:THOMAS, ANTHONY A (PT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:31 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2351
Mailing Address - Country:US
Mailing Address - Phone:718-370-3500
Mailing Address - Fax:718-979-5236
Practice Address - Street 1:17 EASTERN PKWY
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5601
Practice Address - Country:US
Practice Address - Phone:718-623-3500
Practice Address - Fax:718-623-2546
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008624-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ57061Medicare PIN