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General NPI Number Information
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NPI Number | 1003604448
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Entity Type | Individual
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Provider Name | SIJO THOMAS SR.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2025
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 1499 W PALMETTO PARK RD STE 212
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City | BOCA RATON
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State | FL
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Zip | 33486-3322
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Country | US
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Telephone | 561-494-4499
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 NW 53RD MNR
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4610
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Country | US
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Telephone | 786-973-5764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 33868
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License Number State | FL
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