Provider Demographics
NPI:1770890980
Name:THOMAS, DEBRA J (PT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBI
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:342 N SWEET GUM LN
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-7765
Mailing Address - Country:US
Mailing Address - Phone:662-871-4065
Mailing Address - Fax:662-680-5114
Practice Address - Street 1:1200 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38828-6000
Practice Address - Country:US
Practice Address - Phone:662-871-4065
Practice Address - Fax:662-680-5114
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT1003OtherMISSISSIPPI STATE BOARD OF PHYSICAL THERAPY