Provider Demographics
NPI:1457966285
Name:MEADE, THOMAS (LMT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MEADE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 61ST ST # 2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2233
Mailing Address - Country:US
Mailing Address - Phone:212-203-7166
Mailing Address - Fax:
Practice Address - Street 1:3341 61ST ST # 2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2233
Practice Address - Country:US
Practice Address - Phone:212-203-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007120-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist