MEDICARE: SUE THOMAS PT

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		IL

General Provider Information

NPI Number	:	1710947353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE THOMAS PT

Provider Business Mailing Address
First Line	:	421 W EXCHANGE ST
Second Line	:	PO BOX 268
City	:	FREEPORT
State	:	IL
Zip	:	61032-4030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 CHICAGO AVE
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-1716
Country	:	US
Telephone Number	:	815-273-3323
Fax Number	:

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	07/08/2007

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Directions to “ SUE THOMAS PT” Practice Location

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