Healthcare Provider Details

I. General information

NPI: 1083054977
Provider Name (Legal Business Name): SEAN THOMAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 NEW DORP LN
STATEN ISLAND NY
10306-2351
US

IV. Provider business mailing address

660 EMPIRE BLVD 6C
BROOKLYN NY
11213-5254
US

V. Phone/Fax

Practice location:
  • Phone: 718-844-5350
  • Fax: 718-979-5236
Mailing address:
  • Phone: 914-805-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02422000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number008541
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: