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General NPI Number Information
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NPI Number | 1154144301
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Entity Type | Individual
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Provider Name | JEROME CLARENCE THOMAS
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Gender | Male
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 1834 GEORGE AVE
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4103
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Country | US
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Telephone | 443-441-0631
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 SPA RD APT C
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City | ANNAPOLIS
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State | MD
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Zip | 21403-1168
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Country | US
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Telephone | 410-330-5992
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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