MEDICARE: RAEANN SUSAN THOMAS PT, MPT

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	225100000X	Physical Therapist	3557	OK

General Provider Information

NPI Number	:	1679578959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAEANN SUSAN THOMAS PT, MPT

Provider Business Mailing Address
First Line	:	2408 OLD CREEK RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-1537
Country	:	US
Telephone Number	:	405-820-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	3699 NW 32ND ST
Second Line	:
City	:	NEWCASTLE
State	:	OK
Zip	:	73065-6559
Country	:	US
Telephone Number	:	405-387-5520
Fax Number	:	405-387-5404

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/06/2021

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