Healthcare Provider Details

I. General information

NPI: 1275595704
Provider Name (Legal Business Name): CARLA THOMAS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 JACKSON AVE
SAINT CHARLES IL
60174
US

IV. Provider business mailing address

901 JACKSON AVE
SAINT CHARLES IL
60174-3025
US

V. Phone/Fax

Practice location:
  • Phone: 630-346-0901
  • Fax:
Mailing address:
  • Phone: 630-346-0901
  • Fax: 631-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070014240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: