Provider Demographics
NPI:1295173326
Name:THOMAS, ROBERT RANDALL (DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RANDALL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 228TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9301
Mailing Address - Country:US
Mailing Address - Phone:425-391-4488
Mailing Address - Fax:425-391-8287
Practice Address - Street 1:2850 228TH AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9301
Practice Address - Country:US
Practice Address - Phone:425-391-4488
Practice Address - Fax:425-391-8287
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60381438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist