Provider Demographics
NPI:1750536843
Name:THOMAS, VANESSA (PT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 S CAROLINA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102
Mailing Address - Country:US
Mailing Address - Phone:806-803-9517
Mailing Address - Fax:806-803-9518
Practice Address - Street 1:1916 S CAROLINA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102
Practice Address - Country:US
Practice Address - Phone:806-803-9517
Practice Address - Fax:806-803-9518
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1185399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist