Provider Demographics
NPI:1255647269
Name:THOMAS, NELDA JOY (PT)
Entity type:Individual
Prefix:MRS
First Name:NELDA
Middle Name:JOY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:EDWARD
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732-0426
Mailing Address - Country:US
Mailing Address - Phone:601-807-2855
Mailing Address - Fax:
Practice Address - Street 1:27477 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:CORNELL
Practice Address - State:WI
Practice Address - Zip Code:54732-5222
Practice Address - Country:US
Practice Address - Phone:601-807-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4463-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist