MEDICARE: RODERICK THOMAS II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MF001686	PA

General Provider Information

NPI Number	:	1356203293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODERICK THOMAS II

Provider Business Mailing Address
First Line	:	4150 PARKSIDE AVE APT 202
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-7301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 PARKSIDE AVE APT 202
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-7301
Country	:	US
Telephone Number	:	267-428-6732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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