Provider Demographics
NPI:1295731685
Name:THOMAS, WILLIAM R (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7712 OLD CANTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9299
Mailing Address - Country:US
Mailing Address - Phone:601-898-1828
Mailing Address - Fax:601-326-3645
Practice Address - Street 1:7712 OLD CANTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9299
Practice Address - Country:US
Practice Address - Phone:601-898-1828
Practice Address - Fax:601-326-3645
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS650020488OtherMEDICARE RAILROAD
MS00120315Medicaid
MS650000112Medicare PIN