Provider Demographics
NPI:1669954442
Name:THOMAS, ROY K (PTA)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 BILLIE JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5255
Mailing Address - Country:US
Mailing Address - Phone:972-569-7165
Mailing Address - Fax:
Practice Address - Street 1:9009 WHITE ROCK TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-3347
Practice Address - Country:US
Practice Address - Phone:214-355-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2078408225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant