Provider Demographics
NPI:1205894854
Name:MEDCALF, THOMAS EDWARD (RPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:MEDCALF
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:PO BOX 80804
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30366-0804
Mailing Address - Country:US
Mailing Address - Phone:770-512-0466
Mailing Address - Fax:770-512-0322
Practice Address - Street 1:5380 PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2449
Practice Address - Country:US
Practice Address - Phone:770-512-0466
Practice Address - Fax:770-512-0322
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA818225100000X, 2251G0304X, 2251N0400X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Not Answered2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65PCBFLMedicare ID - Type UnspecifiedPROVIDER NUMBER
GA65PCBFLMedicare ID - Type UnspecifiedPROVIDER NUMBER