Provider Demographics
NPI:1265601660
Name:THOMAS, JUANITA CHRISTIAN (PHYSICAL THERAPY LIC)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:CHRISTIAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 TOBIN DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-1434
Mailing Address - Country:US
Mailing Address - Phone:843-662-4499
Mailing Address - Fax:
Practice Address - Street 1:2005 TOBIN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-1434
Practice Address - Country:US
Practice Address - Phone:843-662-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5862251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0094Medicaid