Healthcare Provider Details

I. General information

NPI: 1538650239
Provider Name (Legal Business Name): ROBERT WILLIAM THOMAS II CMT, HHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 BRISTOL ST FL 2
COSTA MESA CA
92626-8605
US

IV. Provider business mailing address

23285 CAMINITO MARCIAL
LAGUNA HILLS CA
92653-1621
US

V. Phone/Fax

Practice location:
  • Phone: 714-424-9001
  • Fax:
Mailing address:
  • Phone: 949-547-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number62792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: