Provider Demographics
NPI:1205590965
Name:THAI, GENE
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:THAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7444 UNBRIDLE WAY APT 203
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2612
Mailing Address - Country:US
Mailing Address - Phone:251-644-1332
Mailing Address - Fax:
Practice Address - Street 1:7444 UNBRIDLE WAY APT 203
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2612
Practice Address - Country:US
Practice Address - Phone:251-644-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL80616225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist