Provider Demographics
NPI:1184600066
Name:PROBST, THOMAS ALBERT (ATC, PT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALBERT
Last Name:PROBST
Suffix:
Gender:M
Credentials:ATC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-1585
Mailing Address - Country:US
Mailing Address - Phone:303-932-0090
Mailing Address - Fax:303-312-2320
Practice Address - Street 1:2001 BLAKE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2008
Practice Address - Country:US
Practice Address - Phone:303-292-0200
Practice Address - Fax:303-312-2320
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist