Provider Demographics
NPI:1932778933
Name:THOMAS, ERWIN JR
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5069 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8271
Mailing Address - Country:US
Mailing Address - Phone:321-303-6276
Mailing Address - Fax:407-537-9772
Practice Address - Street 1:5069 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8271
Practice Address - Country:US
Practice Address - Phone:321-303-6276
Practice Address - Fax:407-537-9772
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist