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General NPI Number Information
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NPI Number | 1679578959
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Entity Type | Individual
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Provider Name | RAEANN SUSAN THOMAS PT, MPT
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Gender | Female
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 3699 NW 32ND ST
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City | NEWCASTLE
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State | OK
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Zip | 73065-6559
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Country | US
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Telephone | 405-387-5520
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Fax | 405-387-5404
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Provider Business Mailing Address
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Address Line | 2408 OLD CREEK RD
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City | EDMOND
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State | OK
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Zip | 73034-1537
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Country | US
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Telephone | 405-820-5075
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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 | 3557
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License Number State | OK
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