Healthcare Provider Details

I. General information

NPI: 1265556567
Provider Name (Legal Business Name): THOMAS P. WERNER P.T., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BEE CAVE RD STE 204
WEST LAKE HILLS TX
78746-5254
US

IV. Provider business mailing address

PO BOX 4688
INCLINE VILLAGE NV
89450-4688
US

V. Phone/Fax

Practice location:
  • Phone: 512-329-6617
  • Fax: 512-329-6772
Mailing address:
  • Phone: 775-745-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13162
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0440
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1194947
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2815-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: