Provider Demographics
NPI:1932534856
Name:THOMAS, GENETTA R
Entity Type:Individual
Prefix:MRS
First Name:GENETTA
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BO
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6108 THACKERY DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0426
Mailing Address - Country:US
Mailing Address - Phone:940-300-3585
Mailing Address - Fax:
Practice Address - Street 1:6108 THACKERY DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0426
Practice Address - Country:US
Practice Address - Phone:940-300-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist