Healthcare Provider Details

I. General information

NPI: 1003604448
Provider Name (Legal Business Name): SIJO THOMAS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2025
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 W PALMETTO PARK RD STE 212
BOCA RATON FL
33486-3322
US

IV. Provider business mailing address

9000 NW 53RD MNR
CORAL SPRINGS FL
33067-4610
US

V. Phone/Fax

Practice location:
  • Phone: 561-494-4499
  • Fax:
Mailing address:
  • Phone: 786-973-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: