Provider Demographics
NPI:1245936848
Name:MOUSA, THOMAS ALFRED (DPT, PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALFRED
Last Name:MOUSA
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 SHETLAND WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-9505
Mailing Address - Country:US
Mailing Address - Phone:941-726-3645
Mailing Address - Fax:
Practice Address - Street 1:4012 SAWYER RD STE 106
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1231
Practice Address - Country:US
Practice Address - Phone:941-706-4964
Practice Address - Fax:941-375-0099
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist