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General NPI Number Information
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NPI Number | 1134673221
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Entity Type | Individual
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Provider Name | JEREMY THOMAS ATC, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/07/2016
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 109 UNIVERSITY SQ
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City | ERIE
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State | PA
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Zip | 16541-0002
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Country | US
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Telephone | 814-571-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 8946 MAIN ST APT 31
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City | MC KEAN
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State | PA
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Zip | 16426-1462
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Country | US
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Telephone | 412-657-2927
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT027708
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License Number State | PA
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