Provider Demographics
NPI:1184318669
Name:RADIC, THOMAS JOHN (PT, DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:RADIC
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 LUTZ RUN RD
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-3849
Mailing Address - Country:US
Mailing Address - Phone:724-889-6905
Mailing Address - Fax:
Practice Address - Street 1:696 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2748
Practice Address - Country:US
Practice Address - Phone:603-429-8427
Practice Address - Fax:603-429-1756
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4970225100000X
COPTL19060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist