MEDICARE: MR. THOMAS IRVIN WASHINGTON PT, M.B.A., ATC

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	1022770	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790152418	OTHER	TX	NPI

General Provider Information

NPI Number	:	1790752418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS IRVIN WASHINGTON PT, M.B.A., ATC

Provider Business Mailing Address
First Line	:	12758 CIMARRON PATH
Second Line	:	STE 126
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3498
Country	:	US
Telephone Number	:	210-615-8844
Fax Number	:	210-615-6959

Provider Business Practice Location Address
First Line	:	12758 CIMARRON PATH
Second Line	:	STE 126
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3498
Country	:	US
Telephone Number	:	210-615-8844
Fax Number	:	210-615-6959

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	10/26/2016

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