Provider Demographics
NPI:1669520193
Name:THOMAS, SCOTT A (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 GRANITE WOODS LOOP
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4135
Mailing Address - Country:US
Mailing Address - Phone:941-493-2487
Mailing Address - Fax:
Practice Address - Street 1:1279 N SUMTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-8021
Practice Address - Country:US
Practice Address - Phone:941-240-8602
Practice Address - Fax:941-240-8607
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106890Medicare ID - Type Unspecified