Healthcare Provider Details

I. General information

NPI: 1649811522
Provider Name (Legal Business Name): CARLA THOMAS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N 2ND ST STE A
SAINT CHARLES IL
60174-1804
US

IV. Provider business mailing address

901 JACKSON AVE
ST CHARLES IL
60174-3025
US

V. Phone/Fax

Practice location:
  • Phone: 331-235-5024
  • Fax: 630-281-4619
Mailing address:
  • Phone: 630-346-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARLA THOMAS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: MPT
Phone: 630-346-0901