Provider Demographics
NPI:1023119278
Name:ABRAHAM, TOMAS ERMIAS (RPT)
Entity type:Individual
Prefix:
First Name:TOMAS
Middle Name:ERMIAS
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 TABOR ST
Mailing Address - Street 2:#215
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4973
Mailing Address - Country:US
Mailing Address - Phone:877-400-0084
Mailing Address - Fax:877-400-0084
Practice Address - Street 1:326 N SOTO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1815
Practice Address - Country:US
Practice Address - Phone:877-400-0084
Practice Address - Fax:877-400-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist