Healthcare Provider Details

I. General information

NPI: 1720223696
Provider Name (Legal Business Name): CHANDI THOMAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N BROAD ST
PHILADELPHIA PA
19132-4534
US

IV. Provider business mailing address

2035 W RESERVE DR
PHILADELPHIA PA
19145-5746
US

V. Phone/Fax

Practice location:
  • Phone: 215-228-2656
  • Fax:
Mailing address:
  • Phone: 240-401-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019619
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT019619
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: