Provider Demographics
NPI:1124078712
Name:THOMBS, STEPHANIE A (PT)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:A
Last Name:THOMBS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6120
Mailing Address - Country:US
Mailing Address - Phone:207-751-1122
Mailing Address - Fax:919-479-8730
Practice Address - Street 1:4125 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2167
Practice Address - Country:US
Practice Address - Phone:919-479-8730
Practice Address - Fax:919-479-8730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212005Medicaid
NCH346512Medicare ID - Type Unspecified