Healthcare Provider Details

I. General information

NPI: 1295731685
Provider Name (Legal Business Name): WILLIAM R. THOMAS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7712 OLD CANTON RD SUITE A
MADISON MS
39110-9299
US

IV. Provider business mailing address

7712 OLD CANTON RD SUITE A
MADISON MS
39110-9299
US

V. Phone/Fax

Practice location:
  • Phone: 601-898-1828
  • Fax: 601-326-3645
Mailing address:
  • Phone: 601-898-1828
  • Fax: 601-326-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1151
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: